anna in med school

Guh!  I’ve been remiss!  Someone more responsible than I emailed me about this great opportunity, and I happily agreed to publicize it on this blog…over a month ago.  Luckily the deadline is still six weeks away!

One Medical Group is a primary care practice designed around the fundamentals of quality medicine: listening, evidence, collaboration, trusted relationships – and more time with patients.

In their efforts to invest in the future of primary care, they are excited to announce the One Medical Group Scholarship Program. The scholarship is open to to any third-year medical students who have an interest in pursuing primary care. The scholarship winner will receive $10,000 which will go towards funding their last year of medical school.

The application will be open on January 10, 2014 and they’ll be accepting applications until March 14, 2014. You can find more details about the scholarship here.

One Medical Group Scholarship Program

Award amount: $10,000 (non-renewable)

Eligibility: 3rd year medical student enrolled at a U.S. medical school with an interest in primary care.

Apply: www.onemedical.com/lp/scholarship

Open date: Jan 10, 2014

Deadline: Mar 14, 2014

Results Announced: May 9, 2014

Contact: contactus@applyists.com (Subject Line: One Medical) or toll free 855-670-ISTS (4787)

Especially for those of us going into primary care, this scholarship could really help knock off a portion of our debt and, as a result, help us be more present and available for our patients.  Check out the essay questions–I actually think I would enjoy writing the one about how technology is changing the patients’ experience of primary care.

We’re going through a little patch of separation anxiety.  It kind of comes and goes on a monthly basis.  When I was studying for boards in December (btw, I passed–officially done with uber long computerized tests for the rest of med school!), Aurelia could not be happier about being left at daycare.  She would squirm out of my arms, anxious to go play on the foam wedge things, and would wave bye-bye to me when I hit the doorway (actually the gesture was almost more like a shooing, as if to say, “okay, okay, get out of here already, and let’s get this party started!”).

But one of our harder days was last week, when I was assigned to an out-patient clinic in the suburbs and therefore had time to drop her off at daycare myself.  Aurelia happily took my hand, guided me around the room, babbling as though explaining to me what the different toys did.  As soon as she seemed distracted and I went to leave, she scrambled back to me crying and took hold of my legs with both arms.  When one of her caretakers came to get her, she struggled furiously, extended her arms toward me, and cried fat, heart-wrenching tears that made tears leap to my eyes as well–you would think that by 15 months we’d both be better at this.  A special woman at daycare was kind enough to send me photos as proof that she really does adjust and get happy/curious about 30 seconds after I leave.

And it’s probably pregnancy + new schedule/adjustments, but I’ve been more emotional recently–oh my goodness, facebook friends, please stop posting stuff (happy, sad, encouraging) about children or cute little animals.  Cannot. Stop. Crying.  When I’m in one of my fits related to Aurelia, John reminds me, “She’s not suffering.”  While I know there’s a great deal on the spectrum between happiness and misery, sometimes seeing some of the really sick children on service helps put things in perspective, and makes me feel a little less horrible about Aurelia’s “not suffering” tears when we part each morning.

Oh god, I feel awful including this next anecdote in the same post, as though somehow relating run-of-the-mill separation anxiety with true illness and loss.  I’m not.  It’s just where I am this morning.

I’ve now seen several children with epidermolysis bullosa (EB), a group of inherited connective tissue disorders characterized by marked mechanical fragility of the skin (and other epithelial tissues) with blistering and erosions following minimal trauma (wearing shoes or even clothing, for example).  They are typically due to certain mutations of keratin, laminin, or collagen (all structural proteins).  Depending on the protein and, therefore, the level or juncture of skin/epithelium affected, symptoms range from somewhat controllable blistering of the diaper and foot areas with little to no change of life expectancy, to diffuse painful blistering, infection and sepsis, esophageal strictures, reabsorption of fingers and toes, respiratory failure with death likely during infancy.

I met a sweet girl who, although not at the extreme end of severity spectrum, was in horrible pain due to persistent blistering.  She is at high risk of developing squamous cell carcinoma (a common cancer in the EB population).  Mortality is often within a year of diagnosis of this cancer.  She is well-loved and has a huge team of health care professionals working to improve her life and minimize pain.  I am very thankful that we have drugs that, although not always adequate and certainly not perfect, can lessen misery.

And so I come home in the evening and my healthy girl clumsily runs at me, happily colliding “full” speed into my legs if I don’t get down to her level quickly enough.  She has a cough that’s lingering, mild eczema on her upper lip from a persistently runny nose, and she now often wakes up with pieces of hair glued to her cheek with snot.  The next day, I know she’ll protest and scream and cry fat tears when I leave to go to clinic.  But I know that she’s not suffering.  The children who are and their parents, they are heroes and inspirations beyond comprehension.  I truly don’t know how they do it.

I’m such a wimp when it comes to illness.  This cold has been lingering for about nine days now, and I’ve been excusing my hacking cough to patients with, “Oh, you know, kid’s in daycare, so it’s always something.”  (Sure, blame the baby, easy target.)  Unfortunately, it seems like Aurelia has now caught said bug from me rather than the other way around, as I hear her now coughing in her sleep through the walls of her bedroom/guestroom/study (truly one day she’ll have her own room and it’s going to be baller).  Mom/responsible med student fail.

And here are two gems from the weekend:

Though on the mend, I was congested to the point of tears on Saturday night (wimp, I know), practically begging John to let me take Robitussin DM.  He looked at me accusingly, “I won’t tell you what to do with your own body, but it’s pregnancy category C; we don’t know the risks to the fetus.”  (Pregnancy categories of a drug serve as assessments of risk toward the fetus.  Simplified, “A” is the safest; “D” and “X” are bad and really bad, respectively.  “C” means that there is some evidence of potential harm to fetuses in animal studies but there is not concrete evidence in humans.)  I retorted, my eyes literally brimming with tears, “Jesus!  Stool softeners are category C.  We don’t do drug studies on pregnant women!  Let me have my drugs!!!”  He might have then texted a maternal-fetal medicine doc who, I’m sure, at this point is really regretting giving us her number, and probably knowing us at all.

The next day, in an effort to keep Aurelia content and not crying to the supersonic level so as to let my darling husband sleep (he’s on nights) while cleaning up a mild mess, I let my daughter play with the bottle with the fun purple liquid.  They make child-safety caps for a reason.  I can’t open them, she shouldn’t be able to either.  I was rinsing a diaper in the bathroom; she was in the next room.  I was gone maybe 30 seconds and things were too quiet.  When I tentatively peered through the doorway, she looked up at me proudly beaming, covered in sticky grape-flavored Motrin, the previously mostly full bottle now marinating our once white quilt overlying the guest bed.  Aurelia was contently slapping her hands into the purple pools, then sucking her fingers satisfyingly.  This, this is why we have children’s rather than infant’s Motrin (the latter of which is of a higher drug concentration) in the house, and why we absolutely do not have children’s Tylenol except in cases of emergency (just listen to This American Life “Use Only as Directed”).

I’m hoping if I give her Motrin before leaving tomorrow I’ll have until 2pm before I get a call from daycare.  Thanks to some god of small things that it’s January and not February, and if you could please keep my babe healthy during my sub-I, I will try not to have a heart attack at age 30.

No cute new pictures today–still in the adjustment phase of being back in clinic.  Seriously, thanks to so many of you for your kind notes and encouragement recently, and I apologize for my perpetual delay in response.  They’ve meant so much to me, and I don’t want to be inconsiderate or seem ungrateful.  So for now a generalized “thanks” with a hopefully more specific one to follow…

Hope you are all staying healthy throughout this mercurial weather pattern.

The first day never fails to intimidate the pants off me.  Feels just like the first day of med school, again and again.  Starting today and for the next 16 weeks, I am in clinic full-time.

I’m starting with pediatric dermatology.  As rotations go, it’s fairly chill and the hours are good.  Yet it’s only the first day and I am exhausted…happy, but tired.  I am optimistic that things will improve once I get back into the routine, and I already feel like my stress level has dramatically decreased because now I know that our childcare plan seems to be functional.  (Of course, this could all be thrown a bit next month when I’m on my sub-internship (sub-I) and the commitment and responsibilities are amped up.)

So here is what we’re doing to make the next 16 weeks possible:

• John has moved to night shifts only (normally starting at 11pm or 12am) so that he can have a regular schedule and be available for daycare pick-up in the afternoons.  I feel like I won the husband jackpot.  Though he assures me that the regularity of his schedule benefits him as well, his sacrifice is enabling me to really be a medical student, to not ditch educational opportunities and patient/team responsibilities in order to make it to daycare before closing.  This flexibility will be especially important on my sub-I month, when hours are longer.
• We’ve hired a morning babysitter before daycare.  If I drop Aurelia off at daycare when it first opens at 7am, the earliest I’ve ever made it to school in the city is 8:20am, not early enough when outpatient clinic begins promptly at 8am, and certainly not when I’ll be expected at the hospital at 6am during my sub-I.  The new sitter is a joy, Ari adores her, and we trust her.  Right now, she comes at 6:15am, but she’ll start at 5am in February.  In some ways, it’s the most painful job, asking someone to be ready to work at 5am.  On the other hand, Aurelia doesn’t wake up until 6:30, and we are more than happy to pay for our sitter to take a shower, watch a movie, read a magazine, catch some z’s while being available should our daughter need her.
• Due to John’s new schedule, there will be a lot of days when we’re all at home around dinner time (well, breakfast time for J).  It’s really lovely.  Phones are put away, TVs and computers are turned off.  Both John and I got to put Ari to bed this evening, which I’m realizing will be so much more tricky once we have a new addition.

And speaking of z’s…Thanks for listening to me being plan-y and insecure!

Supposedly, we’ll have another baby GIRL in four months and change!

Our anatomy scan last week went well–heart, kidneys, spine, brain, diaphragm, limbs, etc. all look healthy and appropriately sized.  But little Miss Modest kept her legs crossed.  The fellow resolved, “Well, I don’t see a penis.”  So we could still be surprised on b-day.

Everyone and his mother predicted that I was having a boy (then again, everyone also thought that Aurelia was a boy).  We had a boy name in mind but a girl name is still very much up for debate.

So far, my favorite suggestions have come from my friend, the Shakespeare scholar…in case you’re in need of some Elizabethan allusions:

Imogen (or Innogen, they are the same character, she’s pretty cool), Rosalind, Celia, Audrey, Phoebe, Nerissa, Portia (i think the character is a brat, but nothing bad happens to her, and she’s smart), Viola (my fav Shakespeare heroine!), Bianca (another brat, but, you know, doesn’t wind up poisoned or anything), Cressida (okay, okay, she gets sold to the greeks…but she handles it well!), Miranda, Marina (she’s pretty solid), Hermione (cool woman, crappy husband), Perdita, Eleanor (of Aquitaine), Beatrice, Titania, Hermia, Helena, Diana

My favorites of this list are Imogen (though John is frankly appalled by this preference), Rosalind, Portia, Viola (also my fav Shakespeare heroine–talk about badass!), and Miranda.

We’ve also been looking at family trees and found such gems as Sorlin and Fidelia (more than one Fidelia) on my side.  (Guy names included Lazareth and Ephraim.)