A New Kind of Hard – 3rd Year

I’m finishing my last week of psychiatry rotation. Like whaa?! I know. I’m a 3rd year. It’s surreal. The challenges of 2nd year and Step 1 is all behind me now, and there’s no turning back.

Ooo, is that my name?! Hehe…umm…do I really know what I’m doing?!

If I could sum up my 3rd year experiences so far in one word, I would say it is “moving.” Definitions (per Google, not in particular order):

  1. Producing strong emotion, especially sadness or sympathy.
  2. Influence or prompt (someone) to do something.
  3. In motion.
  4. Change the place or position of.
  5. Make progress; develop in a particular manner or direction.

Interacting with patients, reinforcing knowledge, and working with a multi-disciplinary team…they all present a new kind of challenge. It’s the kind that drives me to tears not because I got a low score or fear the next set of exams. It drives me to tears because I realize medicine can only go so far. No matter how well the anti-depressants or anti-anxiety meds we prescribe work, we can’t erase childhood abuse or violence in the home. Although we have great plans to transfer patients to a board and care facility for further care, we can’t keep them off the streets if they choose to leave or if they cannot afford it.

I realize, too, the necessary humility physicians must possess to show love and care to patients who may insult us, ignore us, and distrust us. Humility is also needed to admit when we’re wrong, to respond to constructive feedback, to ask for help when we don’t know the answers, and to respectfully listen to people who strongly disagree with us.

Lastly, I learn every day about my own personal limitations. How many emotions from the day can I manage without feeling completely drained by 5 p.m.? How do I keep a healthy boundary between empathy for the patient and my own health? What is the best way to organize all the things – the papers, the emails, the assignments, the sign-offs?!

In the end, I’m human. I make mistakes, I feel hurt when I’m threatened or not appreciated, I feel frustrated when the same patient keeps coming back to the hospital for the same reason, I want to go back to sleep when the alarm clock goes off. But knowing I’m human and knowing that my patients are human too helps me to connect with them in moving ways. Knowing the impact that I can make on someone’s life –  knowing that my hard work is making a difference – makes this new kind of hard totally worth it.

Lessons of the Clinical Year (MS-3)

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Some time in freshman year, we were told that our patients are our teachers. It made a lot of sense, especially in the context of anatomy class where we studied the human body through working with cadavers. Somewhere along sophomore year, buried under review books and lecture material, I slowly forgot that valuable perspective. Now, more than midway through junior year, I am noticing a new appreciation for my patients as teachers. I have pieced together several valuable patient encounters that left special impressions. Here is what my patients have taught me:

You can find strength in places you expect the least

In my hand is a list of children’s names. Next to their names are words such as ‘depression’, ’suicidal ideation’, ‘sexual abuse by uncle’, or ‘physical abuse’. However, in front of me is a group of beautiful children sitting quietly in a circle. One is saying that he wants to be a professional football player and get drafted to Missouri University. Another wants to be a video game designer. In a different occasion, these children are laughing while playing Pictionary. It’s heartbreaking to think about how much pain and sorrow each one of these young children have gone through and yet, they laugh, joke, and behave almost like a regular group of children. They carry such dark pasts with them while at the same time, demonstrate so much hope and potential. Their resiliency is absolutely amazing to me.

Pray with patients when you sense the Holy Spirit working in you

A man was seen in clinic for a referral for an adenoma found on a colonoscopy more than a year ago. He had been referred to a surgeon in the past who wanted to do a repeat colonoscopy. On the day of colonoscopy, he found out the procedure was cancelled by his insurance because this surgeon was not covered by his insurance policy. Frustratingly, the insurance went back and forth for a year before he could have another appointment to address this tumor. Fortunately, the surgical oncologist I was working with was comfortable with attempting to remove the tumor through colonoscopy first and is having a colonoscopy scheduled right away. I was happy for the patient and I felt the Holy Spirit bidding me to pray for this man. So right as the visit ended, I asked for his religious background, got permission, and held his and his wife’s hands as I prayed for a smooth procedure as well as praising God for progress in this uncertain stage of his illness. The second I finished praying, this man stood up and hugged me firmly. I was taken back by surprise by his hug and seeing his wife tear up. I realized there was a reason I felt I should pray for them. The prayer really addressed their burden and worry for the past year since his diagnosis but nothing was done about it. It was a huge weight lifted off of their hearts and I was blessed by their joy.

Prayer is powerful for the patient, but sometimes even more so for the physician

A man in his 70s is laying in bed, looking sullen and depressed. His cirrhosis has caused him to have ascites and pitting edema up to his thighs. He is so fluid over-loaded that he is seeping serous fluid from a small scratch on his flank, soaking his bed sheet. Every morning, he greets me with a gloomy undertone. Maybe it’s because his renal failure keeps worsening and he started on hemodialysis. Or it could be that his new cellulitis at his IV site is too painful. He had been in the hospital even before I joined the medicine team. Just a few days before I was leaving for Christmas break, he commented that I fortunately do not have to be here anymore. Upon hearing that, I knew he was feeling bitter about his long admission and deteriorating health. I felt my chest tighten up because I felt a lot of sympathy for him and I felt like I was not doing anything for this man.

For the rest of the day, I felt gloomy to the point of being depressed just thinking about how this man will spend Christmas holiday in bed while the rest of the world is celebrating. I decided to write him a Christmas card and I gave it to him on my last day. I also prayed with him, asked God to heal him, give him peace, and to help all of his providers to take good care of him with the hopes that he feels cared for and encouraged. After I finished praying for him, he appeared comforted and more cheerful, but I was on the verge of tears. After I bid him farewell, I hid myself in the closest bathroom for a few minutes and allowed tears to pour down my face. I do not fully understand my emotions at that time. There’s been times when prayers moved my patients to tears or immense joy, but I have never been brought to tears by my patients. Perhaps the Holy Spirit was moving in me and I truly empathized with him. Perhaps I was unconsciously saying farewell to someone who had become a friend and I knew I won’t see him again. Whatever it was, I truly hope that the Holy Spirit touched him on that day, comforted him, and sparked an interest in Christ. As for me, I learned that when I pray with patients, I experience the satisfaction and fulfillment of knowing I had done everything I can to take care of a patient’s physical and spiritual wellbeing.

Change is possible no matter what

“I take full responsibility for cheating on you 7 years ago”, he said genuinely as he read his letter to his wife to the other men sitting in a circle. As he continued to read a list of things he takes full responsibility for, his voice started to choke slightly and had to pause a little. I have heard love letters, confessions of love, and even wedding proposals, but so few are done so honestly and genuinely that you would not think he’s exaggerating or making things up to sound good. On the addiction & chemical dependency unit, there are many individuals struggling to quit substance abuse and relapses. It is difficult for me to break certain bad habits in my life, and I can’t imagine how difficult it must be to quit addictive substances and remain clean in the face of temptation for the rest of life. However, it is also in drug addicts that I also find the most spiritually passionate Christians. Romans 5:20 reads, “but where sin increased, graced abounded all the more.” The more wrong a person has done in his life and desires to change, the more he appreciates forgiveness. As I listen to this man’s letter, I realize that I, too, have many areas for growth and a need for forgiveness.

There are so many special patient encounters in the clinical years and I feel these are what give meaning to the practice of medicine. Yes, there is much value in practicing evidence-based medicine and in ongoing break-through research. I do not want to minimize the intellectual aspect of medicine as that is absolutely necessary. At the same time, I am reminded of 1 Corinthians 13:2, “If I have the gift of prophecy and can fathom all mysteries and all knowledge, and if I have faith that can move mountains, but do not have love, I am nothing.” A physician with perfect knowledge but no expression of compassion and kindness to his patients is missing out on some of the best parts of medicine. There’s so much emotional healing and sense of fulfillment in holding patients’ hands, praying with them, getting to know them, and encouraging them. This applies to any aspect of life as well, but being in medicine is a very convenient position to do this. I hope all Loma Linda students will try praying for their patients at least once during their training. We are made with a yearning to be loved, to be cared about, and nothing makes us happier than being in a loving relationship with others. I am truly glad that I will be able to care for patients for the rest of my life and I thank God for this unique environment here at Loma Linda.

I get to be a sorta-kinda-almost doctor now!

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Well, it’s here, that moment we’ve all been waiting for when we are unleashed up onto the hospital wards and allowed to actually take care of patients. No, we’re not doctors yet…but we are 3rd years and with that new title comes the time to close (most of) our books, leave the lecture halls and learn, quite literally, on the job.

This week I began my 6 week rotation on OB/GYN. With my crisp, clean, new white coat with personalized embroidery and blast-from-the-past beeper in hand, I looked like a doctor but sure didn’t feel like one! I would be lying if I didn’t say that I am quite literally terrified of what this year has in store.

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In my past 18 years of education I have mastered the art of having teachers present material to me and then regurgitating it back to them on exams. Classrooms, books, and tests have defined my entire life. But now I have a new set of teachers, my patients, and the final exam is no longer a set of multiple-choice questions, but instead involves the health, well-being, and wholeness of a person.

Today I scrubbed into my first surgery, a vaginal hysterectomy/cystocele & rectocele repair/sling placement, and it was awesome!!! I felt completely incompetent wandering around the halls of the OR suites and mostly just tried to do my best to stay out of everyone’s way. It’s terrifying to feel like I have no clue what I’m doing, but at the same time I know that I’m doing my best to learn fast.

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Despite my best efforts, I know that I will make mistakes. My hope for this year is that I will not lose sight of the fact that each decision I make and the effort that I put into learning during the next 2 years of clinical training will have an impact on countless people either for the good or for the bad. I hope and pray that I will be able to honor the patients that put their lives in my care by learning absolutely everything that they have to teach. I also desire to learn from my residents and attending physicians who have an infinitely more advanced depth of knowledge and experience. I hope that I will not take one moment of this next year for granted for the formative power that it has on my training to be a caring, compassionate, and knowledgeable physician. Despite the apprehension and uncertainty that I feel when thinking about beginning this new year, I am also excited for the new experiences that will come my way!

My First Delivery

Ryan, Third Year Medical StudentIt was early Monday morning, my first day working in Labor & Delivery while on my OBGYN rotation. After my last clinical experience, Family Medicine, when the workday began at 9 AM, waking up at 4:30 AM to finish responsibilities before rounds in the postpartum unit had me yawning and rubbing my tired eyes quite often. I was pretty excited to start L&D after hearing stories my wife, an L&D nurse, would excitedly tell from time to time. But in those first few moments, nothing seemed to shake the fatigue of an early morning. That is, until my attending’s pager started crying for attention.

L&D Team Babienco! #OBGYN #latergram #LLUSM

My Wife & I, Team L&D!

I was warned that between all the students and interns, the opportunity to participate in a delivery might not present itself very often. But there I was, not 2 hours into my first shift and Loma Linda’s newest life didn’t want to wait for rounds to finish before making a sudden appearance. My attending took off, and not wanting to miss an opportunity, I followed, leaving the rest of our team behind in the postpartum unit. “Do you mind if I come too?” I asked, trying to catch up, “I’ve never seen a delivery before!” She motioned for me to follow, not slowing a bit.

Walking into the patient’s room, I discovered a very busy scene. To some, the room might have looked like chaos, what with the 4 family members crowded around the head of the soon-to-be mommy’s bed, a husband helping one of the nurses hold up his wife’s legs as she pushed, and 10 or so other individuals busy with something. But at this point in my medical education, I didn’t see chaos; I saw a well-oiled machine, each health care member working together as a team, covering every need. A senior resident, already gowned up and prepared to deliver the newborn, was standing at the foot of the bed, counting to 10, and telling his patient when to push. There was a small team of NICU pediatricians, ready to assess the newborn (there was some concern for fetal distress). And there were several nurses monitoring vitals and ferrying items to and from mom.

Taking it all in, I was suddenly surprised as a surgical gown package was smacked into my chest. “Better hurry and gown up,” my attending was telling me, “you don’t want to miss this! What’s your glove size?” Wait, she expected me to do more than just watch? Seeing the question on my face, she spoke up again as she pointed toward the senior resident, “You did well on this in the simulation lab, Dr. Brown* will do it with you now.” She smiled a warm look of reassurance. “Now get that gown on or you’ll miss it!”

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Suit up! Typical Delivery Attire

Just as I had learned earlier in the year (à la My Laparoscopic Camera), I had no time to question. I put on surgical boots and a mask, and then carefully and quickly self-gowned and gloved, making sure my outfit stayed sterile. A nurse came up behind me to help tie my gown, quickly followed by the inevitable jokes about my height and how hard it was to reach the Velcro tie at the nape of my neck. But I barely even heard, I was too busy going over the steps of delivery in my head.

As I approached the foot of the table, the senior resident acknowledged my presence and stepped to the side. Now, from here on out, I won’t go into too much detail; as most of you moms already know, some could consider birth a gory experience! At the point I joined the delivery, you could already see the very top of baby’s head, and two or three more good pushes would have us celebrating a birthday. Dr. Brown took my hands, positioned them over baby’s head, then placed his own over top of mine as he helped me guide baby into a new world. “Alright, give me one more good push!” Dr. Brown instructed, looking up at mom with encouragement.

Next thing I knew, a tiny face was staring up at me, looking surprisingly peaceful. We checked to see if there was an umbilical cord around her neck, then delivered each shoulder, one after the other. With one more push and a gush of fluid, I was suddenly holding a baby girl! For a moment, time froze; it was the most disgusting and yet beautiful thing I had every seen. She was perfect, with her tiny fingers, eyes, ears, nose… “Clamp!” I snapped out of the brief moment and held baby as her cord was clamped in two spots, daddy coming over to cut. He was a brawn looking man, and I could tell he was trying pretty hard, and pretty unsuccessfully, not to cry.

Normally, baby would have immediately gone to her mommy’s chest. The practice of immediate “skin-to-skin” helps with bonding, provides warm, and eases baby into easier breast-feeding (among other things), but in our case, the NICU team wanted to assess the newborn due to some meconium present during labor (meconium is baby poo while in the womb; it can indicate distress). As I handed baby to the NICU team, she gave out a hearty, strong cry, and I knew everything was going to be ok. After a quick check, the NICU team confirmed my relief by smiling and bringing baby over for some of that important skin-to-skin time. At this point, dad had pretty much lost his composure as he and his wife embraced their brand new daughter. It’s tough finding words to describe the moment that was in front of me. 100%, unadulterated love. Pure joy.

For me, there was no time to get caught up in the emotion of it all as we still had to do some stuff you never really hear about after a delivery. The placenta still needed to be delivered and inspected, mom’s uterus had to be massaged to help stop postpartum bleeding, and any lacerations from delivery needed sutures. This happened without problem, and because I mentioned my plans of specializing in emergency medicine, I even got to do the suturing! As I took off my soiled gown, Dr. Brown and my attending both affirmed I had done a good job, which frankly, felt pretty awesome. I then washed my hands, gave congratulations to the new family (along with receiving a grip-crushing handshake from dad), and stepped outside the room.

Me with Some of the Coolest Nurses in the Hospital

That’s when it hit me. Oh my goodness, I just pulled a new life into the world!! Pretty cool. I’m so grateful that even though I’ve less than a month left to go in my third year, even with another huge board exam looming over my head, I’m still finding moments like these.  Not to mention in 17 short weeks I’ll be doing this again as the dad!

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My Son at 22 Weeks. 3D Ultrasounds are Amazing!

Even though I thought I couldn’t have any more respect for my mom, I certainly do after participating in that first delivery. Props to my mom and all the moms out there that have the strength to carry us and the patience to raise us into respectable men and women. And with that, there’s less than two weeks to go until I’m a 4th year medical student! Stay tuned!!

*Name changed to protect privacy.

My Stroll

Ryan, Third Year Medical StudentNormally, my posts follow a linear story. Today I’m going to break that format and throw you a couple of random things that have been going on lately!

– I vowed I would not do this while writing posts for fear that I would look like I am trying to curry favor with anyone responsible for evaluations. But because I have already finished my rotation in pediatrics, I have got to throw out massive appreciation for Dr. Catalon, my most recent preceptor. Dr. Catalon runs a general pediatric clinic in Moreno Valley, and I had the privilege of rotating under his guidance for 4 weeks. Not only did I learn an incredible amount under his tutelage, I laughed so often I’m pretty sure I added 10 years to my life! The reason I’m sharing this with you is because so often I’m afraid that young pre-med students or other pre-clinical med students have a preconceived notion that attending doctors exist to haze and embarrass med students. Well, that simply is not true! Maybe things were like that in the early history of medical school, but in my experience, things aren’t even close to as awful as they may be dramatized in anecdotes or popular television shows.

Nom nom nom

Out to Lunch with Dr. Catalon

– At long last, the end is finally approaching. With the recent, very successful match completed by the class of 2014, it is finally our turn to begin the process, to begin “Strolling through the Match.” For those who might not know what “The Match” is, it’s the process by which 4th year medical students get jobs for post-graduate training. Even though one is technically considered a full-fledged doctor after graduation, these residency programs are (for the most part) the final step towards becoming a board certified physician. I won’t go in depth about it as many of my fellow bloggers have recently discussed the match in detail, but I’ll revisit the process throughout the year as I get closer and closer to finding out where I will continue my training. So at this point, my classmates and I are making our final decisions as to what specialty we are going into, setting up our senior year schedules, and applying for away rotations (also known as “audition rotations”). And soon after, we’ll begin applying for residency spots and flying all over the country to impress interviewers everywhere. I have 100% affirmed my decision to apply for residencies in Emergency Medicine, and I could not be more excited!

Exciting!

– April Fools’ Day was a week ago, and my wife and I had planned the perfect prank. It seems that everyone and their pet dog announces they have either gotten engaged or become pregnant on April 1st, so not wanting to miss out, we posted this picture:

April Fools!

Preggo?

You might sarcastically be thinking, “Wow Ryan, real creative joke there.” as you roll your eyes and continue reading. But here’s the best part about our joke… it wasn’t a joke! That’s right, I am proud to announce that my wife and I are expecting our first child this coming October!! Brianna told me by giving me a Valentine’s Day gift… little Cincinnati Reds infant onesies. I was absolutely enthralled. And I still am!

Go Reds!

 

Already a Reds Fan!

 

Boy? Girl?

 

13 Weeks

POP

We are SO Excited!

– I am only 10 weeks away from completing the core rotations required for my 3rd year of medical school: 4 weeks of family medicine and 6 weeks of OBGYN. Soon after, I’ll have another onslaught of exams to survive (nay, defeat!), and then 4th year begins with the fun adventure of matching! Stay tuned, many exciting things to come! 🙂