anna in med school

There were a few instances on my medicine clerkship when it was tough keeping the pregnancy secret.  Trying to show up to rounds without smelling like vomit or, as was the case with one very special patient, having to internally repeat to myself while performing a diabetic foot examination: “I will not puke on a patient today.  I will not puke on a patient today.”–not some of my finest student moments but, in retrospect, pretty comical.  (I can’t imagine what this hopelessly foul-smelling diabetic patient must have thought of his student-doctor, visibly turning green in front of him.)  For the most part, however, I doubt anyone suspected I was in the family way.

Surgery was different.  It was made clear that discretion was not an option.

On day two, I showed up early to OR 8 to prepared for the first surgery.  The 50-something-year-old male scrub nurse was there and I introduced myself.  We talked about the other staff that would be present, the protocols, and other specifics of the procedure.  Then:

Him: It’s unusual for this OR, but we have to use x-ray with fluoroscopy.  I have to ask, there’s no chance you could be pregnant, right?

Me: Uh…yeah.

Him (visibly taken aback): What?!  Well, how pregnant do you think you are?

Me: I think I’m like 11 weeks pregnant.

Him: Uh…yeah, you can’t be here.

At this point, he ushered me out of the room and pulled me in and out of the neighboring ORs, each time announcing to the room, “Hey, got any interesting cases?  Using x-ray?  Anna here is with child, we can’t have her in 8.”  God, I felt so poorly that my classmate had to switch ORs with me.  She had read up and prepared for all her cases ahead of time and offered me all her notes of the procedures I was now scrubbing into to which I had previously known nothing about.  A class act.

I was really worried that the director of the Surgical Trauma rotation, which I started on Monday, would make me switch out due to x-ray exposure.  He’s one of my doctoring preceptors, so I approached him about it last week.  His response was an adorable mixture of hardcore goal-oriented wonder surgeon and soft, cuddly papa-bear:

Do not think for a second of keeping this secret!  Make your pregnancy known to everyone in the Trauma Bay.  Wear two layers of lead while in the bay.  There’s a blue line surrounding each bed that is 6 feet away.  Double that distance when an x-ray is called.  Don’t forget that we’re a team.  We will protect you.  I will protect you.  Oh, and realize that your life is going to get SO much better.  You thought you life was good now; well, it’s going to skyrocket come–when is your kid due?  October?!  That’s even better.  S/He’ll be one of the oldest in the grade.  Read Outliers.  You’ll see, that’s a really good thing.

My patient died on the operating room table today.  Gunshot wound to the chest.

I performed the primary and secondary survey.  It just occurred to me that I was probably the last person to whom he spoke.  When assessing his airway and level of consciousness, he responded appropriately when I asked him his name and that of our current president.  When prompted, he gave me two thumbs up.  Then he was intubated and had chest tubes placed, and we wheeled him into the OR.  And three hours later he was dead.  He was less than 25 years old.

I think it’s time we invested in a camera.

A conversation of today:

Me: A nurse told me today that she was wearing maternity pants at 9-1o weeks!  I consider it a success that I’m almost to 15 and haven’t made the plunge.

Him: You wear scrubs on a daily basis.

Not the best method of making your pregnant wife happy.  But, yes, I do have a bit of a pot–enough to make me look chubby, not quite enough to make it look like I have an excuse.

“Perfect, Anna!  Suck hard and get out quick.”  My fellow MS2 and I were the only ones who saw humor in that statement.

Also, today I got pimped on literary allusions from The Canterbury Tales to Macbeth to “The Jabberwocky.”  Whatever makes a five-hour surgery more entertaining, right?  Don’t remember the last time I picked up a work of fiction, so why am I way better at this sort of question then the “name that vessel” or “list the layers we’re cutting through” questions?

1.  There was an embarrassingly loud thump in the middle of a robotic nephrectomy (kidney removal) when my head hit the wall.  Today, I fell asleep standing up.  I don’t think the nurses believed me when I said I slipped.

2.  I love that there are some cancers that we can cure by simple removal.  Of course, the removal is not simple.  And it’s painful.  And you’re left without a kidney.  But still…no chemo, no radiation, and normal life expectancy following.  In the world of cancer, that’s not so bad.

3.  There was a scary moment toward the end of the day when the surgeons had to act fast to stop a bleeding…the tumor had invaded into some important vasculature.  These surgeons are awesome at their job, and how so many hands work so well all together in a small space is beyond my comprehension.  When things were resolved, the attending stopped for a brief moment and held out his hand to his resident, and they shook hands over the body cavity.

A term invented by a good friend that I think describes one novel experience of the first trimester perfectly.  John explained in an email:

Anna is an absolute champ about the experience, and has only just about torn my head off a couple of times.  I know now, for example, that if she’s hungry I had better get out of the F$#@ way so that she can find some food.  Oh – and that coffee and scotch are now the most grotesque smells on the planet.

One night, John was sipping his single malt and at one point leaned in to give me a peck.  I kid you not, I think I said, “I love you, but I will vomit on you if you kiss me right now.”  Yeah, I’m a catch.

I came home from a long day a couple days ago, famished, and John found my choice of must-haves so perplexing, that he grabbed my phone to document:

In my defense, I really wanted some hot soup, but our ancient microwave was taking forever to heat the stuff.  So I went for the peanut butter for a quick protein fix–this makes total sense to me.  But I was also making chocolate chip cookies for a birthday, and chocolate and peanut butter always go well together, even as an amuse bouche to cream of tomato.  Blueberries with yogurt are simply my fav.  I can eat then anytime, all the time, and I need no excuses.

Numbers make things feel more real.

157 heart beats per minute.

6.8 cm in length.

Due date: 10/20/2012!

John and I are overjoyed to share that we’re expecting our first kiddo this October!  And annainmedschool is about to get a bit more interesting, or at least a little more chaotic, so any and all advice on parenting/balancing careers/managing how to not break your child in the first year of life is welcome here!  (Seriously, please!)

I won’t bore you with all the details at once, so just the bare bones for now:

I’m about 13 weeks along and have been struggling (often failing) to keep things secret.  At this point, I feel comfortable disclosing our good news because (and this is not to sound morbid) I figure that any potential bad news in the future would shake me in such a manner than I would want/have to reveal it anyway.  Right now, the fetus is healthy, I’m healthy, and John is tolerating us like a champ!

I’ve heard enough horror stories about the first trimester to know that I have no business complaining.  However, I will say that the last three months have been both hilarious and fascinating in retrospect, and I’m looking forward to jotting down some of my favorite stories from them!

Finally, a few pictures of us trying to appreciate the process…

The night we found out we were pregnant:

10 weeks (the size of a baby carrot) & 12 weeks (the size of a lime):

(I elected to cut off my head in this last picture because it was taken at 4am [surgery…], and you really don’t need to see my face at that hour.  But, we had bought the lime, so we just thought, “Whatever, let’s just do this is scrubs, then make a breakfast mojito shake or something.”)

After Urology morning rounds, the residents and students had a 6:30am epidemiology lecture.  It was fantastic, a fun overview of the entire epi course we took as MS1s–a class I desperately wish I had taken more seriously at the time.  Clinical trails, they’re kind of a big deal.

Midway through, I couldn’t help but think briefly on what a privilege it is, for my life’s purpose right now to be my own education.  That I really do get to learn new things daily, and will continue to long after med school.  Sounds kind of hokey, but I think sometimes I need to remind myself that this is a really good life, despite the extreme pain in causes me from time to time 🙂

(Also, after having given many mini-lectures (some of which definitely crashed and burned) in the past three and a half months, I feel like I appreciate gifted teachers and speakers way more!)

I have to keep telling myself that it’s ludicrous for a med student to buy cute scrub caps on Etsy (here, for example) for a three-month rotation.  Still, as I resemble more and more like a cafeteria lady in a slightly more opaque form of hairnet day after day, I can’t help but gaze longingly at the adorable scrub caps that the nurses and some residents sport.  They must be good luck too!

(BTW, almost all sellers of scrub caps on Etsy model their caps on mannequins.  The one above is, believe it or not, the least freaky of the bunch.)

It’s when you open someone up who has started to have symptoms of the cancer he’s been carrying around for over a year.  And then you find it much worse than all the CT scans and biopsies could have led you to believe.  And so, after discussing the options with family for an hour while he’s lying open on the table you do what is likely best for him, for what he would want, and that is to do nothing but close.  It sucks.