Saying Goodbye to 2nd Year

Paige-header3

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!:

IMG_1681

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.

 Commencement Dinner 3

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.

1655751_802872326397872_3916717946032464044_o

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.

10293784_787175147967590_329905052730903559_o

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!

I have a pager and a white coat with my name on it???

Kristina, Third Year Medical Student

First year – check. Second year – check. Step 1 – check. Orientation week – check. Tomorrow, with white coat on and pager in hand, I step onto the wards.

It’s both exciting and scary that these mile markers for medical school have passed already. For so many years I have been learning from behind a desk, and now it is time to actually do things.

As I look back on the last two years, it is pretty incredible to see how I’ve changed and been molded to face the changes of medical school. The experience has enabled me to get to know myself in a more raw and vulnerable way. I’ve discovered strengths and weaknesses that I didn’t realize during my college years. If this has only happened in the first two years, I cannot even begin to imagine the changes I will experience in the last two years!

With Step 1 (part one of three board exams that dot the path to becoming an MD) behind us, it’s so interesting to even see the changes my classmates went through in such intense stress. I saw some burning out, some are peaking just at the right time, some in a panic to get the highest score possible, and some at peace with just getting it over with. I realize that we have all come to this point in order to become physicians by mostly studying, studying, occasional OSCE…studying, studying, …and more studying. Yet this is one of the first mile markers of many that REALLY stays with us significantly into the future. I really try not to think of that too much as I wait for my score to arrive sometime in July.

Although it has been draining, I have gained some of the valuable things this year. One of the best things I have experienced is making new friendships and strengthening existing friendships like never before in my life. My friends that I have made in medical school are definitely ones that I will keep for the rest of my life. This is one thing that I have absolutely loved about second year of medical school. In college, I had a harder time getting and maintaining friendships. I’m not sure why. Maybe I spent too much time in the chemistry lab, or maybe I just wasn’t a friendly person! But this year, the hardships have made friendships stronger, and that is something that I will always treasure. Because it’s these friendships that get you through the rough times, and it’s these friendships that make the good times even MORE awesome.

Another thing I’ve really learned this year that has been VERY important for me to “turn off the chatter”. There are always people around you suggesting the newest and best resource for preparing for classes and step 1. The class nearly goes into a panic at the beginning of second year trying to find the best books and notes and flashcards and dropbox pdfs in order to succeed in classes/boards. Early on, I found that this kind of talk reallllly gets to my head. And even though I managed to turn the chatter off first year, I had to do it all over again second year. As a result, my days grew to be spent entirely at home with studying from 6am to 11am, working out, eating lunch, studying from 1pm-6pm (with an occasional 20 minute power nap thrown in), dinner break, then studying from 7pm till about 10pm. Repeat the next day. Yes, it did get a bit lonely at times, but I was MUCH more at peace and much more focused.

This past week we had orientation, which was…..interesting. We had a lot of lectures about smoking cessation, preventive medicine, ethics, and some about how to succeed on the wards. There were ups and downs in my attention span, I will admit.

Thursday night was the clinical commencement dinner for our class at Castaways restaurant. It was so awesome to see everyone in nice outfits, all done up for the occasion! But what I think I loved the most was seeing how relaxed everyone was. Seriously, I don’t think I’ve seen such relief on our faces in all my time here. Now, come our first presentation to our attendings in a few days, I don’t think that will be the case! But, I loved seeing so much happiness then.

The program consisted of a vocal rendition of “Let it go” by some of my classmates (Hans, Ben, Vincent, Jackson, Vanessa) and I along with an encouraging and educational speech given by Dr. Werner on how to succeed in third year (probably the most informative speech of all orientation week). It was an awesome evening of no studying, good food, awesome friends, and a gorgeous sunset.

So in short…third year starts tomorrow. Without a doubt, I am SO happy second year will be over and behind me. But about third year, I’m not going to even pretend like I know what is going to happen, because frankly, I have no idea! I’m sure I will miss the days that I could completely control my schedule and plan my fun activities around my studying. However, at the same time, I so appreciate the first two years of molding me into being a better doctor and a better friend. I have grown in my solitude of prayer and study this year, and now I’m ready to continue growing around patients, attendings, residents, and nurses.

And the saga continues…

Sincerely,

Kristina…now MS3

let_it_go_pic

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”.

cupcakes.2

sandnephron.2

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.

pathophyscookies.2

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:

donewithsurgery

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.

opthoexam.2

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.

match7.2

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.

hollywoodhike

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.

graduation2497

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!”

Untitled

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!

Untitled

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.