How To Have Fun

I’m going to admit something that makes me feel kind of lame: I think I’ve sort of forgotten how to have fun.

The swing at the playground by my apartment.

Don’t get me wrong, I’m completely enjoying my life, but these final months are kind of a weird time in our lives. We fourth years are pretty much done with interviews (see my post on that here), and lots of us are doing electives that are of interest to us.

Now when I go to work I’m excited to be there and when I come home, sure I’m reading on my patients, but I’m not trying to keep up with a mountain of classes or study for a Board and there’s nothing left to do for applications but wait for Match Day in March.

And so I have free time.

Like, daily. 

What? Yes it is weird.

We worked really hard to reach this point. Long long hours in the hospital, overnights, never seeing the sun, so many tears shed over Pathophysiology––I know it’s not just me––and so much stress and travel to get that rank list ready.

And now I find myself startled by the small amount of stress in my life. Which looks SO silly when I type it, but it’s really brought home for me the fact that it’s been a long time since I had time for fun hobbies and I’m not even quite sure of what I really like to do. But I am completely caught up on quite a lot of TV shows right now, and I’m doing my best to try new things.

I might be mostly alone in this, but in case I’m not, I just wanted anyone else who’s feeling this way to know that it’s okay that we don’t remember what we used to do to have fun––we’ve been busy.

And now?

I get to see my friends outside of the hospital AND I get to see my husband.

I’m training for another half-marathon. This was the view from Smiley Heights on my run this morning.

I also bought a fish. It’s a baby betta. If we don’t kill it, it’ll grow up. Her name’s Victoria Dragonslayer, but I really have no idea if she’s actually a girl.

And sometimes I bake. I got out the Kitchenaid Mixer we got for the wedding and it made some sweet banana bread.

These are mostly things I’ve liked to do throughout my time in med school, and I feel weird but completely blessed that I have some time for them as we come up towards the end of these 4 years.

After all, residency will come soon enough.

The Blessing of Interviews

Happy New Year!

Now that we’re all back from a Christmas break that feels too far in the past already, most of us in third and fourth year are back to our usual work patterns and it’s been great running into some of you in the hospital.

Like many fourth years, I took several weeks off for interviews. Prior to coming back 2 weeks ago, many of us have been traveling almost continuously since before Thanksgiving.

I wanted to share a few highlights from my trips, photo style. As I have not yet matched, I won’t be sharing my opinions of programs or my rank list, but I went to a lot of beautiful places.

It all started with this bag my friends gave me for my birthday. It came with me everywhere. It’s giant but fits perfectly under the airplane seat. With this and a small carry-on suitcase, I never had to check a bag. However, since I flew Southwest which checks bags for free, I frequently checked it anyway so I didn’t have to roll it around on my layovers.

This is the view from Morning Report at one of the programs. Wow right?

The southwest was sunny and clear.

Snow all over in Utah.

Oregon’s amazing tram ride.

Boston has really tall buildings.

I tried to walk at least a little in every place I went because I think it gives me the best sense of it. Sometimes I took a latte with me.

I felt like Eloise at the Plaza in this hotel that the program paid for in Ohio.

There was snow on the Grapevine when we went through.

I just wanted to share that interview season, while indisputably exhausting, is a blessing. At what other time in our lives do we get to travel the entire country imagining what our lives might be like if we moved there, see amazing hospitals doing great work and meet piles of people who want to do the same thing.

And after most of them were done and I was bone tired, I got to head home to my parents’ house in Oregon for Christmas. My husband came with me, and relaxing there was that much more enjoyable because of the whirlwind.

Baking with my sister.

Walking our puppy Chaucer on the property. Loving life.

I finished my last interview a week ago, sent all my thank you notes, and after some consideration, I certified my rank list and got this email:

You probably can’t read that, but it says “Confirmation of Certified ROL” meaning, I’m done! I am of course allowed to change it up until February 20, but I have faith God will send me where I belong regardless of what order I put the programs in. I’ve done my best to be honest with myself, but messing around with my list isn’t going to change where He wants me to go, so it feels good to let it go.

So now that there’s nothing left for me to do but wait for March 11 (finding out if we matched) and then March 15 (finding out where we matched) it feels like a strange balance of relief and nervous anticipation.

It would be easy to be anxious, but I’m trying to just enjoy my electives, my friends and this time when my worries are out of my control.

So again, welcome back, have a great week!

Firsts and Lasts

Hi everyone.

Happy Mid-November––have you started the Christmas music yet? I have. Sweaters. Tea. I love this time of year.

This month I’ve been rotating in the Pediatric Intensive Care Unit. It’s a great place to learn and see lots of interesting cases and super sick kids – which is good for education, if a little heart-wrenching sometimes.

A couple things happened in the past week––some firsts and lasts.

First the Last: I did my last overnight call! I think it may be my last overnight call [as in, 28 hours straight] until I’m a senior resident with the new work hours, since we can’t do more than 16 at a time for interns. It seemed sort of weird, but I’m sure the time will fly by until I’m a senior and wondering how it could be only 1.5 years ago that I said, “Yay my last call for ages!”

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Now a First: My first residency interview! I’ll be traveling in earnest after Thanksgiving, but while I’m still on rotation I just a have a couple local ones. I went over to Orange for the UCI/CHOC program, and I would say it was a positive experience. I also wore my new interview suit for the first time.

Here it is in my closet:

Why am I showing you a picture of my suit? Because of this:

Yes, that’s the stitch at the bottom of the jacket that holds the flaps together. I went through my WHOLE interview with it still there – and it was in the full X shape – I just had started to take it out before I took this picture.

So a word of caution, though I’m reasonably confident I’m the only one who would do this, take the tack stitches out of your new suit before you go try to make a good impression. Oh well.

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Another First: the first day with a high below 70! [If you fact check me, you may find that's not 100% true, I really have no idea. But do you really have time to fact check me? Get back to work, crazies.]

Anyway it was truly cold. I went out at 6:30 AM on Sunday and I looked like this:

And, because we’re all a bunch of cold-intolerant creatures down here, proof I’m not bundled up just because I’m a wimp:

28 degrees! It felt awesome.

And so that’s pretty much life in Loma Linda right now––rotations, interviews, finally a little cold.

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As I start my national travels for interviews, I’ll keep you posted.

Now turn on some Christmas music. It’s time!

Power Out: Silver Lining Hunting

This is a story about expectations and circumstances beyond our control.

The power went out on campus last week.

I was in the pool. It was 6 am, so it was pretty dark. They wouldn’t let us stay in because the lifeguards wouldn’t have been able to see us if we drowned. Fair enough.

This is not the first time this has happened. The power going out, not the pool part.

The last time I was on my sub-internship on pediatrics and it was about 4 am. I was on call overnight and it had been plenty busy. There was a crazy thunderstorm outside and the hospital may or may not have been struck by lightning. I’m not trying to start any rumors, I’m just telling you from where I was sitting by the window on the fifth floor, that’s what it looked like.

Residents were furiously trying to finish history & physicals on the new patients so they’d be ready for when the day teams who come in at 6. It’s a sinking feeling when you’re typing along and that screen goes dark. Not to mention if you’re sitting in a room without auxiliary lighting. I tripped over at least 2 backpacks. Fortunately what had already been typed up on the patient saves to the server, backup generators come on for ventilators and things like that so that patients are okay, and our biggest problem was finding some computers that didn’t require the main power so we could keep working.

Point is, it worked out.

Let me preface this next part by saying that I realize my dilemma with this recent incident is small. Thousands of appointments had to be cancelled, patient care gets much more difficult without electronic records given our current system, and I’m sure there were lots of legitimate problems to deal with.

Back to my important workout problem.

I was kind of frustrated. My first reaction was not the peaceful “make the best of it” reaction I had hoped for. I had gotten a bit of a later start on a swim morning than I would have liked. I was only 8 laps in, and had been excited about it being a swim workout day. When forced to get out of the pool, I headed home and resolved to run instead. It’s only a few miles back to my apartment, but in that short distance, I found myself getting angry.

“I can’t believe I drove all the way here and now I’m just driving back to run around my neighborhood. I could’ve saved that gas.”

“This is my own stupid fault, I would have been almost done if I’d gotten there at 5:30 like I planned instead of sleeping that extra 20 minutes.”

“I’m wet and chlorine-coated for nothing.”

“This totally throws off my morning timeline. I was supposed to be studying pretty soon. Do I skip the workout altogether? What’s worse? Stupid power.”

“Also I’m starting to get hungry. This is going to delay breakfast. I hate that. I want my oatmeal.”

And so on.

And as I cycled down this path of whiny self-pity and frustration, I heard myself and realized none of those thoughts would make anything better.

I had an expectation: being able to swim and complete my workout at a certain time.

It was not met because of circumstances beyond anyone’s control. So I took my frustration and went on a run.

Here’s what I found:

Forcing me to go later meant it was light outside and I saw a lot more beauty on the route than I expected. Also it gave me that push to feel like I was a little pressed for time – which shoved me past my usual procrastinating ways and led me to actually get things done today.

Here’s what I’m trying to say: There’s something good to be found in all the things that happen that I can’t control and when I look for it, things get better. 

I’m not going to draw any direct parallels to medicine, but I might think on it.

Wait, I lied.

In this time when I’m about to start interviewing at programs and traveling around the country, I’ve no doubt there will be numerous logistical circumstances beyond my control. It’s probably good I’m practicing my silver lining hunting with something tiny like an early morning swim.

Step 2 Clinical Skills

Or: We know you do this every day, but you still have to come show us you’re a basically decent english-speaking human who learned something during medical school.

For more information from the USMLE on Step 2 CS, here’s the official site.

The only thing in this picture you take in with you is the coat and stethoscope. Time to leave all the other notes behind.

As a first-year medical student, I remember hearing vague rumblings of the part of the education where you have to see a standardized patient and demonstrate your clinical abilities.

And I was terrified.

I have to know what questions to ask? I have to decide what’s the right physical exam to do? I have to use equipment without bashing anyone in the head?

These were my fears.

Fast forward 3+ years, and right between my honeymoon and starting this Pediatric Infectious Disease rotation in Ohio, I headed out to Los Angeles to take this exam.

Step 2 Clinical Skills is the final component of Boards taken during medical school, sometime towards the beginning of 4th year. It consists of 12 standardized patient encounters––15 minutes in the room for history and physical, 10 minutes to write a note. Our closest location is Los Angeles, but it’s offered at a few sites around the country on multiple dates.

I want to share a little rundown of my day, but here’s the bottom line:

From the time our wonderful Physical Diagnosis staff first teaches you to use that dang blood pressure cuff in first year, you are preparing, and when it comes time to take the test, you’ll be ready.

Though you may still put the blood pressure cuff on backwards. True story.

Step 2 Clinical Skills by the Hours

At the link at the top of this entry, you can watch the orientation video that gives a pretty good rundown of the day. This is more an editorialized experience.

Day before: I think it’s a good idea to travel to wherever you are taking the test and find the building the day before; it will decrease your test-morning anxiety. I took my test on a Thursday, so on Wednesday afternoon I headed out to LA and checked into an airport hotel. I picked the Hacienda Hotel because it was cheap and super close to the site. Like if my car broke down I still could have walked close, but it was super old and a little sketchy, so use your own judgment there. I brought my husband with me, and his statement was, “I’m really glad I didn’t let you come here alone.”

6:00 AM: Alarm sounds and I got up. The plan was to be there at 7:30 AM, with plenty of time for getting ready and eating breakfast.

6:45 AM: With breakfast at the attached diner completed and my taste buds sufficiently assaulted with terrible coffee, we headed across the street to Starbucks for something palatable. I spotted someone else carrying a short white coat and looking nervous. Good to know I’m not alone.

7:25 AM: I entered the Pacific Corporate Tower building 125 after John dropped me off, walked onto the elevator and did not see a button for the 13th floor. It only went to 10. Turns out there’s 2 banks of elevators––one for 1-10, one for 11-20. I’m so small town, I had no idea. When I finally found the right one, someone spotted my coat and wished me good luck on the way up.

7:29 AM: There were a few other students sitting around in the hallway on floor 13, and the sign said the doors would open at 7:30, so we just waited.

7:30 AM: After showing our test permits and ID to the secretary, we were directed back to an initial holding room and assigned a number. There we all sat around for awhile in assigned chairs while everyone arrived, we got white stickers to cover up names and logos on our coats, and we read some instructions. I used the time to appreciate how different everyone was. It was someone’s 45th birthday, there were multiple foreign accents, some long coats and some short. It would be another interesting day for the standardized patients.

Some time after that: We gathered up our things and went to the orientation room. (That’s right, holding room, THEN orientation room. 2 rooms.) We were allowed to keep food, lip balm, mints/gum and meds at our assigned chairs in this room. Everything else got put away safely in a locked room. I kept a pack of gum, some chapstick, and all the food I’d brought––trail mix, snap peas, a luna bar and an apple. During this time they also showed us the orientation video, available at the website at the top of this post.

8:30 AM (I think? Really all these times are going to be guesses): After making sure everyone had a chance to use the restroom and take a deep breath [I'm telling you, these proctors were super nice] they lined us all up in order of our numbers and took us to our starting stations.

And…..GO!

Without saying anything about the cases, I think the combination of OSCEs in 3rd year and the MACY we took in July (a California-based sort-of practice CS with 8 stations) gave us a pretty good idea what to expect.

I was nervous, but I finished in most rooms right before the signal that time was up. Of course, as I typed my note I kept thinking, “Oh I forgot to ask that!” “Oh my gosh what if it’s this, I didn’t even do a ______ exam!” So pretty much the usual. I chose to take the approach of a little more time outside the room jotting a differential and physical exams I might want to do. Then once in the room, I pretty much didn’t write unless there was a med list.

Around 11 AM: After 5 stations, we had a 30 minute break. There was food provided: sandwiches, salad, fruit, cookies, but I kept it light with some salad and my luna bar. What if I slipped into a food coma in the middle of a patient encounter?

I’ll be honest, at this point with 7 to go, I felt like the day would never end. However, I think at this point at least the nervousness was mostly gone.

11:30 AM: 4 more stations. I think it was around station 7 that my history-taking really started to drop off. I didn’t expect to feel so brain-tired so early, but I found myself stumbling over words and sitting in longer and longer silences while I regathered my train of thought. I kept finishing with enough time, I just didn’t feel as energetic. There was one station I wasn’t quite sure if a full CV exam was really indicated, but didn’t know what to do next, so I just sat there thinking while I listened to the patient’s carotid. It’s possible she thought I fell asleep. Not sure.

1:30 PM: Another 15 minute break. I had some snacks and began to see a light at the end of the tunnel––3 to go!

1:45 PM: Another 3 stations. I am not kidding you, I think my final patient of the day thought I was a little slow. I must have summarized/repeated his answers at least 3 times to make sure I had the story. He was starting to look at me like I wasn’t quite with it. That’s not to say his case was complicated––my brain was just really tired.

3:00 PM: After turning in our final scrap paper we were allowed to retrieve our bags, given our proof of attendance printout, and we could leave.

Then John and I took a 3 hour IKEA shopping trip because my new apartment didn’t have any furniture. It was very therapeutic.

Overall, I certainly don’t think I crushed it––there was something I thought of later that I didn’t address on every patient, and on a couple I really wasn’t that confident in my differential. However, the process felt familiar, so in October when I finally get the result we’ll see if my feeling reflects reality.

For now I’ll say this: trust the process. I think you’ll be ready.