How Am I Going to Learn Enough?!

I am so frustrated right now. I've spent the past few days reading about ventilator management, lung volumes, and acute respiratory distress syndrome. We've covered congestive heart failure and why the traditional way of thinking about acid-base disorders is incomplete. However, for some reason I just can't get questions right when people ask me point blank. For instance, even though I read an article my preceptor suggested a few days ago, I just couldn't summarize it when he asked me to this morning. What has happened to my recall? In high school, that wouldn't have been a problem. In fact, I think memorizing medicine in general would have been easier in high school.

I'm quite sure the British system does have something over us -- they take kids right out of high school and teach them, so they still have the ability to stay up all night and study, or memorize things as soon as they read them. I don't know if my brain is aging or rusty, but it's just maddening to know that you can't recall something that you thought you knew. Today, at the end of the day, a neurologist was quizzing me about locations of strokes in the brain. I *knew* this stuff at the end of last year -- and now it's gone -- poof -- like the wind. F*%K. A great way to end the day, looking like an idiot in front of your senior resident. Terrific. I'm being quizzed about everything except the lung on this pulmonary rotation.

And here's the twenty-four million dollar question: If I don't have this stuff memorized now, when on earth am I going to have a chance to learn it? How am I ever going to become the type of doctor I want to be -- the kind that understands physiology, biochemistry, and disease? How many times a day can I feel like a complete idiot? When will I know how to manage patients on my own? What the hell is wrong with me? Seriously, just shoot me now.

The child upstairs is singing 'Colors of the Wind.' The most relevant line from that song:

You'll learn things you never knew you never knew.

It's clearly a song about med school.

Anyway, there has been another milestone in the process of becoming a doctor: I have my basic lifesaving skills card, and I actually performed my first real CPR during a Code Blue in the ICU on Friday. It's physically more demanding than I realized. He was in shock, of a type that has a very high mortality, so the prognosis was unfortunately grim from the start. Then I had to call the family to let them know that the patient had passed away. I was grateful that my resident trusted me to make the phone call myself.

You know, what they don't tell you about medicine is that it's not the long hours, the terrible things that happen, or the yuck factor that makes it difficult. For me, the long hours are fine as long as I have enough food; the patients are the brightest part of my day, even if things are taking a turn for the worse, because you can't just abandon people if things go to pot; and the yuck factor is negligent because I was fortunately given a strong stomach. It's the doctors. The residents sometimes, and the senior doctors often. Some of them have a gift for teaching students, but most do not. They personally resent the extra work teaching requires, no matter that they chose to remain in academics. A few seem to particularly enjoy humiliating medical students, especially if there's an audience or a competitive aspect involved (like grades).  I guess it does make them look smarter, but how are they going to feel when one of those junior doctors is the one taking care of them when they grow old? The Hippocratic oath involves promising to teach the next generation of doctors as though they are your own lineage, not as though you are shooting fish in a barrel, and I hope I remember that if/when I get to that stage in my career. Hazing went out with the baby boomers.

For this reason, I am dreading my presentation tomorrow. What should be an opportunity to present and learn something will instead become a who-can-take-turns-outshining-the-dumb-med-student session. Am I the only one surprised that many doctors are, to put it mildly, not very nice people?

Okay, done venting. Mom and Dad, it's still worth it. Make change from the inside, and all that.

I'm So Terrified.

Medicine is terrifying. On Monday, I officially begin the first rotation of my fourth year. I will be expected to know more than I did last year, to care for patients more fully, to have memorized a larger percentage of relevant facts. That is scary enough; but at least the damage I can do to my patients will be limited by the supervision of those above me. One thing that really scares me, though, is being expected to teach third years. I do not know enough to teach third years! I've been off the wards for an entire year. I have no idea what I'm going to do or how I'm going to learn the material I need to learn. This afternoon I am having a little attack of nerves that makes it hard to breathe, let alone study. I'm going to go home to my nice B and spread my books out on the dining room table and try to get some work done. It's just difficult to read and process information as though you have all the time in the world when you have a Clock O' Doom ticking in the back of your mind.

Change is Good. Change is Good. Change is Good.

"The old order changeth, yielding place to new

And God fulfills himself in many ways 

Lest one good custom should corrupt the world."

-- Lord Alfred Tennyson, The Passing of Arthur

Here I am, just before another corner. Friday was my last day in lab. On Thursday, my lab took me out to lunch at Pacific Catch at the corner of Lincoln and 9th, which was amazing. They gave me parting gifts -- a pediatric rheumatology textbook from my boss, a cute cardigan from our senior technician, and yummy hand lotion and tea infuser from my junior mentor. I brought them thank-you gifts, but was touched to receive things from them. I think the art of gift-giving is dying. It's sad. But that's another blog post. Anyway, with the lab folks, I really felt as though we had managed the true spirit of giving something you think the other person will like because you appreciate them and were thinking about them. One way to achieve this is to limit spending. Small consumables are more likely to make it into the "how thoughtful, I'll definitely use this," category.

Lab bench, all cleaned up before I leave for good.

The last few months of the research year are over. It's been fun. One highlight was a student conference at the Mayo Clinic -- technically it was free, but I have yet to be reimbursed :(. I roomed with a Pharmacy student, and we even went running by the river in Rochester.  We saw goslings! Rochester is a really cute little town. They are trying to encourage diversity, which means our waitress didn't know how to pronounce the eight very non-Christian names at our table, but actually cared about how to say them. The conference was interesting, but the food was unfortunately better than the content. You know there's something wrong when a poster you stumble across on your way to lunch is better than any of the day's speakers, keynote included. That said, there was some *amazing* student work presented. Out of three keynotes, the last was actually mind-blowing (pun intended) -- a neurosurgeon who has been part of a team that is inventing an implantable chip to measure neurotransmitter levels (like dopamine) in the brain, and then transmit the information to a computer. Amazing!! There will be so many applications for the technology.

Another random, cool event was my old high school best friend, Div, coming in from Dubai! She was visiting her brother on the peninsula and they all came up to the city for dinner, so B & I joined them. We ate at Udupi Palace, a South Indian restaurant. Delicious but precarious -- the dinner plates were literally too big for the tables, so the edges were hanging off the sides over our laps! Div is doing well, and unofficially planning a wedding! She's in banking, not a bio teacher as she originally planned, and I'm going to be a pediatrician, not a lawyer like I was thinking about in high school.

High school friends, 10 years later!

I'm trying to write a personal statement for residency. Meaning that I'm thinking about trying to write a personal statement about residency. It's much, much harder than I anticipated because I'm switching fields. All my research and volunteer work has been in aging/rheumatology up until now, and now I'm shifting gears entirely and working with kids and embryology. Somehow, I have to articulate my trajectory, the 'ah-ha' moments, and why I want to work with kids. I feel like there is an entire category of things -- exams, personal statements, impressing my supervisors -- that I'm no longer rocking. Nia needs her groove back. Ah, well. If you can't beat 'em, just keep plodding forward.

B is home from DC. People keep asking how married life is. It's awesome, because I'm rooming with my life partner. It's so worth it. It's something I'm grateful for every day. We celebrated our one year anniversary by running Bay to Breakers, which is a 12K (7.5 mile) race that starts down by the San Francisco Embarcadero and winds its way through the city and Golden Gate Park to end at Ocean Beach. It was on my bucket list, and B kindly agreed to run it with me. I was the 6202nd runner to cross the finish out of 23, 072, and the 1853/11,793 woman, at a pace of 10:22 minutes/mile (1 hour 17 minutes overall). Not too shabby. B was my coach and ran with me, instead of jetting on ahead. Nice B! Che and Rica did B2B as well, walking in costume (thousands of people dress up), and we all met up at the end for tacos!! Yum. Che was a naked lady and Rica was a superhero. My favorite costume was the guy who dressed up like he was riding an ostrich, with feet dangling on either side of the bird, so it looked like the ostrich was running the race. My least favorite costume was The Silver Surfer -- running behind his reflective outfit was like having a glaring mirror in my face for three sunny miles. I also enjoyed seeing the Salmon, who always run the race as a 'school,' backward from Ocean Beach to the Embarcadero (going upriver to spawn). I almost got a salmon high-five. The most popular costume was a pair, running as the Lorax and The Tree -- the tree was nearly 8 feet high!

I am going on vacation.

The next two weeks will be packed: Open House party this weekend with our friends & my parents' friends, etc, and then a week of very intense review/getting things done before my pulmonary rotation. The Open House will be a nice break from reality. We are sending the cat on vacation to my parents' for the party, because my mom wants to attend and she's allergic to the cat. My dad saw our place last week, took one look around at the mess, and said, "Well, since our friends (meaning real adults) are coming, you can host the party at our house if you want." Thanks, Dad. Thanks a lot. But then, he has many strengths beyond tact. I hope the weather is nice so we can go outside. I don't remember much clinical medicine, so I need to study like crazy. I bought and borrowed the books for my rotations, and they all weigh a ton. I really hope 4th year works. I am excited to study more focused areas of medicine than I did with my longitudinal clerkship. Also, wouldn't it be nice to have an MD?

Here's the To-Do:

Open House!
Study pulmonary medicine
Study neonatology
Study child neurology
Write personal statement for residency
Research rheumatoid arthritis paper
Write rheumatoid arthritis paper
Meet with pediatrics department chair/advisor
Come up with list of residencies to apply to
Get photo taken for residency
Ask research mentor for a recommendation letter

Busy = Happy.

Love,
Nia