Saying Goodbye to 2nd Year

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Many people have said that the second year of medical school is the hardest and most grueling year of all.  I’ve heard countless people tell stories of how busy, exhausting, and completely consuming 3rd year is, but it is always followed up by the statement, “But I’d take just about anything, including getting hit by bus, over 2nd year.”

To be completely honest, this was in fact one of the most challenging years of my life for reasons that extended far beyond the rigorous course work that we were faced with each and every day and the ever-looming presence of Step 1 (the exam that makes even other medical licensing exams cry themselves to sleep out of fear).

HOWEVER, I can honestly say that despite the challenges that we faced this year, I will look back on 2nd year with fond memories and a never stronger sense of the presence of God’s guiding hand in my life.  Let me take you through a quick whirlwind tour of what the end of this year was like and what made it so challenging, but I promise there’s a light at the end of the tunnel so keep reading!

From January on, the only thing that 2nd year medical students across America have on their minds is Step 1. This is the mother of all exams; it is 8 hours long and covers all of the content that we have learned in the first 2 years of medical school – anatomy, physiology, cell & molecular biology, immunology, behavioral science, biostatistics, preventive medicine, biochemistry, pharmacology, pathology, pathophysiology, psychiatry, and neurology.  Now this test wouldn’t be such a big deal if it didn’t have so much weight toward which field of medicine we will ultimately be able to enter.  It’s basically the MCAT of residencies and our scores will either make us eligible for competitive specialties like surgery, ophthalmology, radiology, or not.  The saddest part, in my opinion, is that students who may excel in those fields because of their clinical skills and passions may not have the chance to experience those professions because this exam holds so much weight in residency applications.  This was one of the things that I struggled with the most near the end of the year.  I watched countless classmates, who I know will be incredible healers struggle beneath the weight of the pressure that this exam places on students.  The tensions were certainly high and at times the morale was low, however, I can say that the silver lining through it all was learning to trust more in the fact that God has called us to this place to serve in a profession that he will placed us in.  If he has gotten us all this far, then surely he will see us through to the end.

Despite the challenges that we faced during 2nd year, I promised that there would be a light at the end of the tunnel.  Medical school is a process that is so much more than simply learning how to be a doctor; it is a process that challenges people at the very core of who they are and I can honestly say that I have enjoyed that challenge.  I’ve been stretched and forced to grow in ways that I could have never imagined.  I have been required to search for the true reasons why I chose to enter this profession.  I have made the best friends of my life because of the common struggles that we have faced together.  I have been inspired to grow in my walk with God.  I have learned more than I ever thought was possible.  And I have been humbled by the realization that I will never be able to learn everything there is to know about the workings of the human body.  Although the process has been challenging, frustrating, and seemingly impossible at times, I now stand on the other side of the first two years of medical school and can say with confidence that I wouldn’t change anything and would do it all over again in a heartbeat.

 

I would be remiss if I did not take a moment to thank the incredible people who helped make this year both meaningful and enjoyable!:

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My study buddies, Scott and Justin.  We met both years for 2 hours almost every night, 6 hours every Sunday, and ran through at least 45,000 flashcards – about 15,000 cards times a minimum of 3 repetitions. I couldn’t be more blessed or more thankful to have had them by my side through this journey.

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My fellow “Carrelers,” Keri, Krisalyn, Melissa, Stephen, James, David, Linden, Casey (not all of whom are in this picture). I spent my afternoons studying with these wonderful friends in the Study Carrels of Alumni Hall throughout 2nd year.  I have been continuously inspired by each and every one of them and have been spiritually and emotionally uplifted by each of their friendships.

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Dr. Werner, our famed professor of Pathophysiology and the Dean for Medical Student Education to whom we owe our gratitude for continuously inspiring us to never stop learning and to be the absolute best physicians we can possibly be.

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And my classmates, who I love with all my heart!  Coming to Loma Linda and joining these incredible, talented, brilliant, God-fearing, and all-around absolutely wonderful people was the best decision of my life!

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.

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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

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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! 🙂

Questions

Leanna, Fourth Year Medical StudentThere have been some questions asked of me and statements said to me, especially during third year, that I’ve had to think long and hard about answering, making sure I didn’t say anything too weird or inappropriate.

1) “You must be so smart!”

At first, before med school even began, I may have actually secretly agreed with this well-intentioned compliment. I did decently on the MCAT and got interviews and acceptance to some great med schools – thus, in my mind’s eye, I imagined continuing my strong undergrad performance in medical school. Wrong. I cannot even begin to describe what a shock it was, realizing how different undergrad and medical school were. Not that my undergrad education didn’t prepare me well, but medical school demanded 500% more effort to simply pass. As I alluded to in an earlier post, I eventually realized how to change up my study habits and outlook about halfway through first year. Essentially, any decent grades or exam scores I have received since that point I can attribute solely to hard work.

Of course, having some degree of natural intelligence/sound reasoning is quite helpful too, but I passionately believe that medical school is still 90% extraordinarily hard work – hard work that entails ongoing sacrifices of a social life, normal emotional life, and even a little of your soul (I might be kidding about that last one – or maybe not). “Balance” is a great idea and a term that is thrown around a lot, but the “balanced” life of a solid medical student is skewed heavily towards his/her school and away from nearly everything else that a normal twenty-something year old experiences.

First and second year demand incessant studying. Take a day off if you are convicted in that regard, but the other 6 days of the week must be devoted to school. If they aren’t, you will fall drastically behind, or even fail. You will log onto Facebook and see friends and family incessantly posting pictures of hiking, traveling, shopping, – things that are now reserved to Christmas break or the rare full weekend off. What the heck did you do with your free time before you started medical school? During third year, and maybe even a rotation or two of fourth year, you will be waking up when it is pitch black and coming home when it is pitch black. Someone will ask, isn’t it really hot in Loma Linda right now? And you won’t know because you’re inside the hospital all day, on inhumanely long shifts. To receive honors on a third year rotation requires that you pass the respective board with flying colors (implying that you’ve been studying every moment of downtime you have – while eating, in the bathroom, grocery shopping, while on the treadmill), that you have consistently given 110% hard work on the rotation, especially when being watched by residents and attendings, and that you have done all the additional “if-you-want-to-receive-honors” requirements, such as writing pathophysiology papers and scoring well on quizzes. Third year is not a year of rest; it is all the mental demands of first and second year now coupled with performance and application based on that material.

My sheer hope is that this in no way comes across as a pity party. I want to simply dispel the notion that medical school requires of one to be placed on a pedestal; no, it is being an extraordinarily focused and devoted student for four straight years that will get you to graduation. Like I mentioned, intelligence still plays some part, but at least in my case (and I know many who would agree with me), the energy that keeps me going has little to do with intelligence but everything to do with raw diligence and perseverance, driven by a passionate thought of there is no other career in my life that I would rather be doing (honestly though, being a stunt women would be really awesome).

2) You speak Spanish?

Usually, I am tempted to say that I do – well, that my Spanish skills are decent, and if we are not looking for an in-depth conversation, I can get by. Unfortunately, trying to instantaneously translate as a patient is talking to me can be quite tricky.

Recently, in fact, I was in GI clinic and listening to a conversation between the doctor and the patient (both of whom are native Spanish speakers), while trying to translate in my head.

Doc: So how are you feeling?

Patient: Fine; I am thankful to God for the blue horses, and my family’s legs

Doc: Excellent. It appears to me and to you that to me that you appear to want to see results of the scopes.

Patient: Yes. Give protection and truth.

Doc: Everything is breakfast.

Patient: Why is running cancer?

Doc: Cancer is a low probability [YES. Got that one]

Patient: Next year we repeat the trip to the small shoe store?

Doc: No, in three years we repeat scope and tears from the sky, along with stomachs and arms.

Patient: I am confluent with you doctor. God bless you and your beetles.

This may be a slight exaggeration, but have it be known that I greatly look forward to refining my Spanish during the rest of my career, because I really need to do so.

3) So Women’s Health clinic went well today?
YEEEEEAAAAAH I’M THE PAP SMEAR QUEEN YO! (Note: This is never, ever, ever an acceptable Facebook status)

4) How do you do it all, remembering and retaining all that medical information?
Comfort food (Garlic and butter croutons during the week; frozen yogurt on the weekends),
Friends (someone to pat you on the back and remind you that your life has a small bit of inherent meaning to it. Regardless of the fact that your surgery attending’s main goal is to pulverize any self-worth that you have),
Exercise (cardio step classes set to mash-ups of Eminem/Justin Bieber – a mega dose of inspiration)
Incessant studying (see question #1. Do have any idea of how many times I have had to focus on my portable pharmacology flash card set while standing in line at the grocery store, and resist the temptation to read the tabloids’ headlines of Paris Hilton’s set of quintuplet love children with Bigfoot? Many times)

5) Tell me about one of the greatest challenges that you had during medical school (naturally this question is asked quite a few times by my interviewers during the residency interview season)
Well, off the top of my head one of the greatest challenges I’ve faced during medical school was on my surgery rotation. I was on a two-week block of vascular surgery and was waking up at 3:45am to make sure that saw all my patients in time, updated the list in time, began my notes in time, and providing offerings to the gods of vascular surgery – the vascular fellows and attendings.

Anyway, by the time rounds were underway around 8am or so, I was famished, starving, nearly emaciated. On this particular day, I had eaten blueberries and a junky little 90-calorie Special K bar that morning. Naturally I was desperate for food, anything. And as luck would have it, the first patient my team and I saw that morning was sitting up in bed, eating a tasty, mouth-watering meal straight off of the gourmet Loma Linda VA Hospital breakfast menu. Pancakes and no-sugar-added maple syrup, with a cranberry juice box and a link of dry sausage. I couldn’t help my staring – the food was right there in front of me, at that delectable lukewarm room temperature I so craved.

It wasn’t long before the patient caught me staring, my eyes glazed over as I the thoughts of eating one of those little silver dollar pancakes ran through my mind. I want that. I want that pancake. Please. Give. It. To. Me.

“You want this pancake?”

The patient was asking me this. What? No. No. How did he know? Was it the shrieking sound of my stomach over the beeping med-surg monitors? Possibly. That wild hungry look of a castaway lost at sea for a month? Perhaps. Did he know that I had been up since the wee hours of the morning running off of a Special K strawberry breakfast bar? Eh…I suppose so, if he had excellent intuition.

Nevertheless, I was in a major dilemma. Do I accept this patient’s kindhearted gesture and cram the pancake in my mouth while we are debriefing with the attending about the care of the patient? Or do I refuse this offer that may potentially save my life and prevent a fatal hypoglycemic episode in order to save face with the vascular team and prevent myself from going down in Loma Linda VA history as The Girl Who Ate The Pancake?

Fortunately for my reputation, and unfortunately for my stomach, I found a happy medium of gently, kindly refusing the patient’s offer and asking him to please enjoy his entire meal for me (in my mind, it was like YEAH YOU GO AHEAD AND EAT THOSE PANCAKES RIGHT IN FRONT OF ME, BUDDY) while I paid attention to what was going on in the discussion of the patient’s recovery and prognosis.

That afternoon I got a huge Caeser salad and curly fries, and at the end of the rotation I received an excellent letter of recommendation from the surgery clerkship director. So, I think my self-control paid off and I am a better person because of it.

Family Day 2014

On February 14, 2014 we celebrated Freshman Family Day. Families traveled from across the country and around the world to visit their medical students and graduate students. The evening featured the Dedication service, in which each student was given a Bible and then all the students recited the LLUSM Physician’s oath.

This video follows student bloggers Tiffany and Daniel throughout the day.