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.

How did a year go by so fast?

Tiffany, First Year Medical StudentWow I cannot believe how much I have learned this year! After completing 2 weeks of tests, one week of normal in house exams and one week of finals/national mock boards, I wasn’t feeling super knowledgeable. I was wondering was this whole year a waste? I was exhausted and literally going blind from studying non-stop for 3 weeks. But now I am on wards in Internal medicine and I can clearly see how much I have learned. Everyone says that you’ll be amazed by how much you learn but I didn’t know how amazed I would be. I recognize some basic medications, bio-chemical pathways, visual signs of diseases, tests, and lab workups. Instead of just nodding at what the residents are saying I actually understand almost every word and for once in my medical career I do not doubt that I can do this. I was even able to complete a history and physical exam. Don’t get me wrong there is still SO much that I do not know but I am confident that in 3 years I will be able to graduate and become a competent Intern.

My first year of medical school has been filled with many ups and downs. Good grades and not so good of grades, days when I felt like I learned a lot and days that I felt were a complete waste, and feelings of excitement for what my future holds and feelings of terror for what my future holds. Some days I had to remind myself that this is an opportunity I have been working towards my whole life and have even begged God to give me. I would never have been able to make it though this year without the incredible support of my family, friends, husband and God. What has gotten me though the hardest of days is knowing that I am pursing a career that I know God has called me to do. And He doesn’t make mistakes so obviously I am supposed to be here. Since I was a little girl I have felt that I was put on this earth to be a physician but it wasn’t until later in my life that I realized it was God’s call to service that I was experiencing. I thank Him for giving me this chance and believing in my capabilities when I didn’t believe in them myself.

Here’s to two more weeks on pediatric wards and then summer vacation! I will be running a summer camp research project and traveling to Greece, Turkey and Austria with my mom. It’s going to be a busy but fun summer. See you all in the fall.

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.

Match Day 2014!

As our fourth year bloggers have mentioned, we recently celebrated Match Day here at LLUSM.

Here’s your chance to share in the excitement first hand! The 2014 Match Day video follows Leanna, Stephanie, and Erik as they learn which residency programs they will attend.

Changes

Hayley, Fourth Year Medical StudentIn two and a half weeks the familiar faces of the class of 2014 will be lining up with hats, robes, and tassels to celebrate the completion of medical school. Many people say “medical school has flown by!” But as I think back I can remember the different years, the different flavors, the different themes. There have been so many changes – new friends, new relationships, new habits, new life directions – in both my life and in the lives of those nearest and dearest to me. I want to tell you what I remember of the four years in medical school and if you are in one of those years and feel like your life will never change, you can feel comforted knowing change is always around the corner in medical school.

First year:

New. Everything was so new. I couldn’t believe I lived somewhere where palm trees grew! Centennial complex was shiny, new, and so big! The cadaver lab was formidable. The lectures were intense – and there was tons of information to learn. Many of the subjects I had already had in college – biochemistry, anatomy, physiology – so sometimes studying felt boring. Also I wasn’t always sure why what I was learning was important. The application often evaded me. But I was a Medical Student. I had that brazen confidence of first year students. I was used to being the top in college and confident my mind could grasp anything professors cared to throw in my direction. When people asked me what I was going to be, I confidently told them I was going to be a Doctor.

Second year:

Overwhelming. First year is hard. Second year makes first year look easy. So Much Information. I felt like I was constantly drowning in a sea of pathologies I should know. Cloistering myself in the study rooms in alumni hall kept me focused… I would last there 8 or 9 hours until I got too hungry or tired or my eyes couldn’t focus anymore and then I would trudge home with my bag of books, ear buds droning Goljan, till I got home and could get out a “fun” book – something like clinical microbiology made ridiculously simple – to read while I ate something. Then out for a walk with the flashcards I had been pumping out all afternoon, then back to my bedroom to flip through some powerpoints and pathology slides. Repeat times infinity – or at least that’s what it felt like.

So many flash cards

So many flash cards

I remember one time during second year I went to the bank and needed to talk to a teller about something. While I was waiting in line I almost started crying just from the stress of being out in public and having to talk to strangers. I felt like I couldn’t even cope in society because I was so sequestered all the time. And then of course, as second year students are wont to do, I began to worry I was developing agoraphobia (which I had just recently learned about). When people asked me what I was going to be, I told them I was hoping to be a doctor someday.

Third year:

Busy. Being on a clinical rotation is much like being in a small boat tossed by the whims of the ocean. Sometimes the sailing is smooth and you can go where and when you want, but often your direction is completely out of your control – your schedule fluctuates dramatically from one week to the next as your team shifts or your rotation switches. There is really no pattern that can be established. In my scant time off I was constantly reading review books to try to prepare for the inevitable board exam at the end of each rotation. But third year is no second year. Seeing the faces of patients, understanding that the hours I had poured into learning meant something, made a huge difference to my morale during third year. I was excited to read about sarcomas because I wanted to learn more treatment options to talk about with Ms. X. I wanted to know why enterocutaneous fistulas stayed open so our team could move Mr. Y toward resolution of his large EC fistula. Everything had a lot more meaning for me. When people asked me what I was going to be, I told them I was learning to be a doctor and hoping to go into obstetrics and gynecology.

Asleep in the physician’s lounge between surgeries – instead of waking me up when the next surgery started, my attending texted me this picture.

Asleep in the physician’s lounge between surgeries – instead of waking me up when the next surgery started, my attending texted me this picture.

Fourth year:

Unique. I feel like no other year in my life will ever be quite the same as the fourth year of medical school. The first third of the year is intense – sub-I’s (sub-internships – where you attempt to play the role of an intern on your team) back-to-back, collecting letters of recommendation, the step 2 board exam, filling out the online application forms and the stress of wondering if you will receive interviews (you will – unless you completely disregard Dr. Shankel’s advice).

Then the middle third of the year is consumed with flying all over the country, evening dinners with crowds of people you don’t know, endless small talk, and always – “why do want to go into obstetrics and gynecology? Why do you want to come here?” Cities I interviewed at included the greater LA area, Palo Alto, Seattle, Portland, Minneapolis, Rochester MN, Denver, Chicago, and Boston – as you can imagine it is quite a feat to coordinate interviews especially when interviewing in specialties like OB-gyn when the program often only has 2-4 days on which they interview between October and January. Some programs just told me a day that I was going to interview.

One of my interview trail essentials – dry shampoo.

One of my interview trail essentials – dry shampoo.

When the flurries of interviews are over and the ranklist is formulated there is an interminable period of waiting. Waiting. You are aching to go to your number one, but you try to stay on okay terms with the top six on your list so you won’t burst into tears on match day.

Then match day comes. The tension is unimaginable. It is the culmination of everything you have been striving for tirelessly for the past four years. I remember the long hours in the cadaver lab first year, the even longer hours bent over pathophysiology notes during second year and the sleepless nights on surgery in third year. Did it pay off? You open the envelope and suddenly there are no more possibilities. There is just the one reality and that is your future.

And now, when people ask me what I’m going to be, I tell them I am going to be an obstetrics and gynecology resident at University of Washington next year.

Extremely happy on match day!

Extremely happy on match day!