anna in med school

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.

It’s been a big week.  I felt like week 1 on surgery (last week) was mostly orientation and trying to figure out which way to spin when the scrub nurse helped me into the surgical gown.  The second week of a clerkship is always a little better…still felt totally out of sorts with limbs flailing and heads spinning, but not like a complete burden to both surgical team and patient.

This week consisted mostly of hospital-eat-sleep-repeat, with little slivers of studying and no reflection or writing.  Therefore, I’m backdating some entries that I want to make sure get written before I forget some truly novel (to me) moments!

In the past two weeks, I’ve probably worked the most with this quintessential tough-guy surgeon who is, let’s be honest, absolutely phenomenal at what he does.  Not that it matters, but I decided that I really liked him when he cranked his favorite Pandora station during a 10-hour surgery and unembarrassingly admitted, “I’ve been told the music I listen to is that of a 13-year-old girl.  I agree, and I could give a —-.”

Yeah…I don’t think I’ll ever be able to hear Jessie J without thinking of him.

Yesterday and today I gave two presentations.

The first was to my fellow students and the attending in charge of medical student education; it was on the topic of Wilms tumor.  Unlike last week’s presentation when I got my ass handed to me, this week’s went much much better.  This doctor is kind of a scary man upon first encounter–tall, lumbering, and so serious.  But he is a phenomenal, albeit intimidating, educator, and brilliant physician who is completely devoted to his patients.  And when he does flash the rare, slight smile in my direction, I can’t help but feel a wave of relief and approval; he might as well have given me a gold star.

Today was a presentation on the use of laparoscopic adjustable gastric banding in severely obese adolescents in front of the entire department, including a surgeon who did a fellowship in bariatric surgery.  To say I was careful with my words is an understatement.  I dodged a bullet since the surgeon who has a reputation for grilling medical students mercilessly happened to not be there this afternoon.  Instead, the team threw me a few softballs following the presentation, then entered into their own philosophical debate on the subject.  A quick smile and nod from the attending described above signaled my dismissal.

Of course, it could always have gone better.  I still notice soft catches in the back of my mouth, a few stumbles over words, but in general I feel like I’m not quite so afraid of my own voice.  I look at the attendings, even residents, who use so many big words and never say “um.”  I wonder how long it took them to get there; I wonder how long it will take me.

Today was there was an oversight of which I was the beneficiary.  A resident was not assigned to the first surgery in my OR, so the attending pointed at me, “What’s your name?  Looks like you’ll be assisting.”  It was my fifth day in an OR and one of my favorite days of medical school so far.

It was a laparoscopic appendectomy complicated by a previous perforation.  Don’t worry, the surgical attendings here are so flippin’ talented, they would be just fine to have anything with a pulse be their assistant.  Still, instead of my usual 90% observing-10% retracting during a surgery (no complaints, it’s always a privilege), I felt like I was actually worth the air I consumed in the OR today.  I guided the camera, searched the abdominal cavity for other locations of infection, stapled, lassoed, and sutured.  There aren’t words to describe the rush of it.

After we closed and de-gowned, the attending went to sign off on the operative note.  After a few minutes she called everyone who wasn’t involved in the waking of the patient over and pointed to the top of the note that read:

Surgeon:    Dr. ————–                   

Assistant:  Jesus                                      

“I’ve never had Jesus as my assistant before; how many doctors can say they have??  I wonder what the family will think.”  I’m foreseeing this being a thing for the rest of my career, but it still makes me smile.