anna in med school

This is what my anesthesia attending said to me following my first attempt at intubation on a live person, followed by, “You’ve seen The Matrix, right?”

Clearly, I was not exactly successful.  Everything seemed to go smoothly, except for my initial difficulty wedging open the mouth of a woman who was missing, or in the process of, most of her teeth.  Then we didn’t see her chest rise and fall with the next breath, and the end-tidal CO2 monitor didn’t record its characteristic wave with the next exhalation.

“And we’re in the esophagus.  Been there.”

Med school does terrible, wonderful things to one’s sense of humor.  In the final days before the surgery shelf, I know a lot of us are going through the Carlos Pestana Surgery Vignettes (for the first time, for the fortieth time).  I sincerely hope what our predecessors said about them being written gold is true.

Perhaps because we’re all so tired of studying the same but slightly altered scenarios, the answers for which will likely still succeed in eluding us in five days, the times when Pestana demonstrates an underlying playful snarkiness becomes a welcome comic release…for example:

The middle of the neck is packed with structures that should not have holes in them.

Let’s count the ways in which potassium has been pouring into her blood…

Yes, Carlos, let’s.

And if you really need a 6:55 break from the grind, check out my former post-bac classmate in the Undacova Gunnaz:

A resident to his student:

Always ask the nurses what they think, and take their advice.  They know their patients; they know their shit; ED nurses are never wrong.

On Friday, I had my “mid-clerkship review” (two weeks from the shelf, and two weeks after I completed all my other surgery requirements) with the director.  After a few minutes of feedback, our conversation shifted to advice on where to find the best nursing bras and on how to be a mother who also happens to be a surgeon.  When I looked across the desk at her, I saw a woman who was young, brilliant, beautiful, a little silly, kind, down-to-earth…who seemingly had it all.  Though I’m not convinced on surgery, it’s hard to not be a little inspired by that kind of figurehead.

There were a few moments during Penn Preview (a shopping weekend, if you will, after admission notices and before tuition deposits) when I started to have an inkling that I should go to Penn, one of which was listening to this director speak as we watched a laparoscopic procedure on the flat screens of the Flyers/76ers Surgery Theatre.  She said, “During my clerkships, I tried to like anything but surgery.”  I just loved the idea that, although you can certainly still have autonomy in choosing career paths, there was a certain element of the field choosing you (a little like the sorting hat).  And I loved even more the kind of moxie it requires to take the hard road because you know it’s where your passions lie, and no where else.

The surgery department still feels like an old boys’ club.  But when I look back at my eight weeks, there were three high-powered women who I admire so much, who stood out as shaping the direction of their given specialty and each seemed to have succeeded in getting everything they could have wanted, both professionally and personally, by being talented, working their asses off, and having skin thick enough to withstand the criticism and chauvinism that must have been much more present during their training.  One of these women hopped on the exercise bike next to me a the gym last week as I had just about had enough; she kept me on the bike almost an hour longer than I had intended just because I was hanging on her every word.  At one point she said, “I’m so thankful my memory is short.  If I could remember how awkward I was in med school, all the poor presentations I must have made, the hostility and criticism I received during training, I would have a hard time showing up for work, let alone having confidence in the OR.”  And to think, she didn’t even have mentors like herself along the way.

They have a refreshing lack of pretentiousness and bullshit about them.  Guess it makes sense that I’m married to one.

This group has been commenting on an article written about our old high school: The new Thomas Jefferson? It includes remedial math.

Many of us were humanities kids who happened to be good at math and science, and we quickly re-shifted our focus in college.  The required advanced math and AP courses I groaned about in high school allowed me to not have take a single one in college…that didn’t look too great when I was applying to post-bac programs.  However, never once during the process were my science and math skills questioned, “Oh!  You went to TJ?  You can definitely handle premed.”  Mildly ridiculous, and a poor assumption.  And then there was the time I was told by a physician in Boston that my TJ diploma would be more helpful than my UVA diplomas in getting me into a good med school.

So, I have mixed feelings on the opportunities (real or imagined) that TJ has provided for me.  Nevertheless, as has been mentioned by several others of the y’s and hmc, attending this high school was one of the best decisions of my life.  There was significant personal sadness during my high school life, but I still believe that mine was a happier, more fulfilling high school experience than that of many of my colleagues.  Beyond the academic rigor that was fostered more by the students than the faculty, I’m one of the few people I know that still has 20+ close friends from high school, let alone still goes to the beach with them for a week every summer.  (Less than a month until Beach Week XI!)

I don’t really have specifics from the article on which I’d like to comment (this is not meant to be a persuasive editorial, just a splatter of unorganized thoughts), but I’m not sure this kind of change is one for the better.  The best part of TJ, in my mind, was the community of eager students with varied strengths but similar aptitudes it brought together.  Am I being closed-minded by not seeing the benefit of a fracture in the foundation of that community?

The mango noticeably moved/kicked for the first time last night!  I think it might have been a little pissed.  John jabbed at my uterus a couple times after we thought we might have felt a little nudge.  The kid is probably like, “Okay!  Stop shaking my home now!  I’d like to continue my organogenesis in peace, please!”  A little preview of the probably 18+ years of annoyance our offspring will feel toward us.

John and I had a date night yesterday.  If you’re in Wayne, PA, we recommend Matador.  Try the octopus.

I was going to include this next bit in my last post, but I didn’t want my sometimes displeasure with my current career state to detract from John’s accomplishments.  That said, from talking with colleagues, I think this is a fairly common situation for med students who are partnered with others (or have close friends) who play more the part of the successful adult career guy/gal in the relationship, while we are still in our 20+ year of schooling.  I thought it important to at least make mention.

Sometimes when I see all the wonderful ways he contributes to his profession and our family (being our family’s breadwinner and fixing all the appliances I break due to either clumsiness or ineptitude, to name a couple), I can’t help but ask (mostly in jest), “What are you doing with me?  What do I bring to this relationship?”

And without pause, “You bring happiness.”

He’s good, isn’t he?

I don’t mean to be self-deprecating here.  I get called out for being too self-deprecating.  Yes, it’s important for young women to be confident, I get that.  But isn’t it also a marker of confidence to not conceal our insecurities?  To make them public so we can actively address and conquer them?

I feel like a theme of this week has been the conflict between loving being a student (all the privileges and opportunities, protected time to learn and soak in so much) and hating being a student (the frustrations that come with feeling like you’re spending some of your best years n0t creating anything).  I know it’s an investment; I know I need to do the training.  And right now I’m sort of limiting my scope to my professional, not personal, contributions.  But, every now and then, I really just want to be of immediate use.

John wrote a book during residency.  Who does that, anyway?  His passion, innovation, brilliance, and work ethic astound me daily.  And I’m so happy and proud that this 368-page labor of love will be published this August!  Available for purchase here and here.

I kind of feel like I married a rock star or something, only without the substance abuse and, of course, this is way better!

Yesterday was my first shift in the ED.  I performed an ultrasound-guided peripheral IV cannulation with an 18-gauge needle (for the record, that’s pretty thick…thickness increases as the number decreases) on a man with disseminated intravascular coagulation (this is not a condition you want to have; it makes you bleed a lot…so it’s a little scary for the person prodding you with needles).  We use ultrasound to guide IV access in patients who tend to be pretty sick, either in shock or have a disease process that will make access to their veins tricky.  It’s not brain surgery, but it requires some coordination–if you’ve seen me walk (heaven help you if you’ve seen me attempt a dance), you know that coordination is not my forte, so you can imagine my relief/exhilaration at having pulled this off!