“What fiyu cyaan bi unfiyu” (old Jamaican saying). Translation: What is meant for you will be yours.

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“In their hearts humans plan their course, but the Lord establishes their steps.” Proverbs 16:9

When God blessed me with the opportunity to enter medical school, I entered with tunnel vision on becoming either a plastic surgeon or neurosurgeon (my childhood dream after deciding that Little House on the Prairie life probably wouldn’t cut it).  I mean what little child reading Ben Carson’s story doesn’t want to be a surgeon? For years I wrote essays for school about the complexity of the brain because nothing else excited me.  I didn’t want to be open! This is what I had planned to do for God, and this is what I would do.  I planned on being that woman who came into medical school with a plan, and left accomplishing that same plan.  I wanted to be set and have no surprises.

But then there was that little voice. You know the one that tells you to keep your options open although you already have a plan?  While on the short clinical rotations experiences during first and second year, treacherous thoughts came into my head.  Why was I beginning to find the beauty in other fields of medicine? How could this be possible? This was NOT supposed to happen to me:

I was not supposed to melt over the children in the pediatric wing, want to cry over the stories of the kids in the psych ward, or feel helpless beside the old woman with 5 fatal diagnoses.  I wasn’t supposed to have fun while playing “video games” on robotic surgery at the OB/GYN interest meeting.  I wasn’t supposed to laugh with the internal medicine doctor and an old war veteran at the V.A. hospital, or watch with interest in the neurology clinic as a mother with occipital neuralgia received injections.  I was not supposed to feel excited as the physical medicine and rehabilitation doctors talked about their plans to make a fake downtown city to help their PT patients acclimate back into society.

I was not supposed to enjoy talking with the old couple at the ophthalmology clinic about how sight isn’t really appreciated until it’s gone, nor was I supposed to be fascinated as I stared into the eye of a man who had received cataract surgery.  I really was not supposed to be interested as I watched a doctor calm the fears of a teenager braving a long needle into her eyelid to treat a chalazion.

My eyes had been opened. There was no turning back. Could I still become a plastic surgeon or neurosurgeon? Sure! But as painful as it was to come to the conclusion, I was beginning to realize that going down a slightly different path than originally planned does not always alter the outcome. It does not always change the dream.  My dream was ultimately to become a Christian doctor that not only enjoyed what she did, but could also put the passion of her enjoyment into the caring of her patients.

On the bright side, I am just about to finish my first week of third year.  This means that I have a little time to settle in my mind which field is for me.  It is always good to have a plan, and it is even better to be able to stick with that plan. However, sometimes it is the unexpected twists and turns in life that make it fun (at least when we look back on it), that help us to grow, and that help us to become the people we always wanted to be.  In the end with an open mind and willingness to make mistakes, what was always meant for us will be ours.

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!

Learnings

Leanna, Fourth Year Medical Student

In the past several weeks I’ve matched to USC’s internal medicine program, graduated medical school, and now am preparing for residency (i.e. filled out 100+ pages of paperwork and bought Pocket Medicine and new shoes). The things I learned about medicine, becoming a doctor, myself, and life during these last four years of medical school are far too many to confine to a blog post, but I’ll note some of the more entertaining and blog-able ones here.

MSI: First year – year of the basic sciences:

I learned that my new best friends would likely be the ones who made art projects with me, art projects with the titles of “Cell Lineage Cupcakes” and “Sandcastle Nephron: a beach study in the functional unit of the kidney”.

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I learned that in order to get decent grades in medical school you had to make huge sacrifices in all other realms of life, sacrifices that I did not have to make in undergrad and at first had a hard time making during this transition.

I learned that from the moment you tell someone, I’m studying to be a doctor, inevitably one of the next questions would be – Oh good, can you check this out for me and tell me if it’s anything serious? Or, sometimes his or her next odd question was, You mean, like a nurse?

Conclusion: I had no life, and far fewer friends than I was used to, but I was okay with it.

MSII: Second year – year of pathology/pathophysiology

I learned all the different ways a person can die (there are a lot).

I learned that pathophysiology is best studied as a group, with cookies.

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I learned that when a professor says, “This concept will be on Step 1”, the entire class wakes up and poises ready with their pencils/iPad note-taking software.

I learned that I could walk around the Drayson Center track for up to three hours at a time while listening to audio lectures.

I learned that while listening to audio lectures at Drayson Center track I ran the risk of getting hit in the head by a stray soccer ball [I learned this lesson twice].

I learned that some of the Step 1 study books had the stupidest study tips, such as, “Just remember the simple acronym AINBIBYXDYAHTGUVI for all the causes of liver failure and you’ll never forget ‘em!”

I learned that the best friends I made in first year were indeed still my best friends and fellow soldiers in the war against overwhelming exams and boards.

MSIII: Third year – year of clinical rotations and the beginning of the hospital hierarchy

I learned that all residents can be bribed, whether they are conscious of it or not – sometimes with food, sometimes with compliments.

I learned that the diseases that in prior years were confined to pages and chapters were infinitely more fascinating when seen up close in a living, hopefully breathing human being.

I learned to act quickly and seriously with the pregnant woman with a life-threatening lupus flare and for the man with a rupturing abdominal aneurysm, and how to lean towards empathy instead of apathy for the patient complaining of non-descript fatigue.

I learned that I loved internal medicine and family medicine and neurology and wilderness medicine and psychiatry and endocrinology and emergency medicine and cardiology and gynecology and critical care and pediatrics.

I learned that Hour #1 of a hernia repair and abdominal adhesion lysis surgery is fascinating, but Hour #9 is not (note that surgery did not make my aforementioned list of rotations and specialties that I love).

I learned that surgeons, upon finding out that I was moderately intelligent and strongly considering primary care as a career, had no inhibition when it came to constantly telling me that it would be a waste of my mind to go into primary care. And this was discouraging.

I learned that there was no possible way to describe my joy and relief with ending my surgery rotation other than this picture:

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I learned that a benevolent neurologist who lets multiple students practice the opthalmoscopic exam (imagine the Death Star killer beam that destroyed Alderaan in a single blast being emblazoned onto your retinas) on her, is a saint and I hope the Vatican City or the Catholic Church or whatever recognizes her as such eventually.

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I learned that as much as I liked doing rotations at White Memorial Medical Center, doing several months’ of rotations there instead of in Loma Linda distanced me from my fellow classmates and disintegrated what little social life I had.

Without a doubt I learned the most during third year. And as I looked back at the beginning of third year compared to the end of third year, I realized that maybe, just maybe, I was actually getting the hang of this doctor thing.

MSIV: Fourth year – year of marketing yourself to residencies and awkward spare time.

I learned that I would have a very hard time choosing between internal medicine and family medicine.

I learned that I loved diversity, puzzle-solving, variety, primary care, and hospitalist medicine, and because of that finally chose internal medicine as my residency path.

I learned that I would have A LOT of time off. What is time off? What do I do with it? Should I study? Should I sleep? Should I go to a pound and adopt another rabbit? Should I read War and Peace? I’ll bake some cupcakes.

I learned how to better practice grace and patience when a family member or friend tells me that they don’t “believe” in Western medicine and prefer only “natural” routes [Hint: arsenic, cyanide, and a variety of lethal mushroom are all “natural”…this could be a topic for a whole different post].

I learned how to be a wife, and in that taking on my husband’s last name of Wise, being called “Dr. Wise” sets quite a high threshold of excellence to which I will be held. Sometimes I wish his last name was Dumb, so that I could be Dr. Dumb and not too much would be expected of me.

I learned on the residency trail that an emphatic “Nope!” is a perfectly acceptable answer when asked if I have plans for specializing after residency.

I learned that Match Day is like a combination of eHarmony, the football draft, the Harry Potter sorting hat, and that part of the Hunger Games when teenagers are chosen to go fight to the death. The last comparison is the most accurate.

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I learned that I liked sushi.

I learned that graduation and all the festivities involved was going to feel extraordinarily surreal, almost joke-like. I’m – graduating? What?

I learned that graduation would be horribly bittersweet as the incredible people I’ve met over the last four years would be leaving to go their separate ways around the country.

In retrospect, I learned that all our well-meaning deans and administrators were morbidly incorrect when they told us during first year, Before you know it, the next four years will fly by and you’ll be graduating! No no no, the years creeped by like a elderly arthritic sloth pulling a wagon full of turtles. With slugs and snails and all other slow things cheering him on.

I learned of all the beautiful hiking trails in the immediate LA area and experienced many of them for myself, some of which for the first time.

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On May 22rd, 2014, I learned that I had officially completed all the requirements for my M.D., and May 25th, I walked with my best friends to receive my doctorate of medicine.

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I learned that the most fierce and profound last four years of academics have brought me to a point where I am entrusted with the well-being of others.

I learned that as a doctor, I am swearing to be a life-long observer, innovator, and of course, insatiable learner. My future patients are my new teachers, the exams will be based on the degree of my patients’ health and wellness, and the hospital and clinics are my full-time classrooms.

A deep gratitude to Loma Linda University for setting me on this path of learning, and to my God for sustaining me with so many blessings, and His promises for my future.

[For any folks who are interested, I plan to be blogging at wisemd.wordpress.com during residency]

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.

Outgrowing My Short White Coat

Ryan, Fourth Year Medical StudentMy white coat doesn’t seem to fit anymore.  I haven’t gotten any larger through medical school, so it’s not that.  My wrists stick out at the sleeves, the hem rests roughly at my hip bones, and the pockets are up so high that putting my hands in them makes me look like I’m doing the Chicken Dance.  But it’s always been that way, and that’s not what I’m referring to.

I know what orders I should write, but I can’t write them.  I can write a fantastic progress note, but it doesn’t go in the chart.  Nurses ask me management questions and I know the answer, but I have no authority to give the answer.  I can form an air-tight assessment and plan, but no one can bill for it.

It seems I have outgrown my short white coat.

It didn’t used to be this way. I remember trying on my first white coat, on the first day of medical school, in that little room underneath the Dean’s Office. It was perfect, a pristine symbol of learning, of caring, of healing. And it didn’t fade for awhile. I loved physical diagnosis labs, freshman ward experience, and continuity clinic during first and second year. I looked up to the third and fourth year students in their white coats, which were actually embroidered with their names. They would come in to Centennial Complex for their OCSE practical exams, and I knew that they were stepping back into the simulator from the real thing, the opposite of what I was doing.

And at the end of second year I picked up my two brand new, pressed, embroidered, personalized white coats, ready to start clinical rotations. That was an even more meaningful symbol for me than the original white coat. I had arrived. After two years of basic science study, I was actually learning how to take care of patients. It felt good to put on that white coat and to wear it around. It meant something.

Now, that symbol is old. I don’t like wearing my short white coat anymore. I feel like it’s holding me back. I’ve done all of my clinical rotations, been in the surgeries, learned the operative indications, repaired the lacerations, counseled the patients, and passed the exams. I’ve matched into an orthopedic surgery residency. Now when I put on my white coat, it feels way too short.

It’s not that it’s bad to be a student; I couldn’t have gotten to this point without going through it. And it’s not that it’s bad to have a short white coat; I could only learn how to be a resident by being a student. It’s just that I’ve outgrown it.

And that’s the way it should be.