Shells on my Beach

2012-01-25T19:09:00.000-06:00

I've been back in the states and back at work for 2 days now. I. Miss. Peru. I set out to find new perspective at this point in my life, meet new people, and truly experience the soul of Cusco and Machu Picchu. I can honestly say I achieved my goal in so may ways.

My absolute most favorite thing about the trip was in fact, not Machu Pichu. I loved seeing what an incredibly spiritual place it is without a doubt. But to be honest, what I loved most about Peru was the rich culture of people that are overwhelmingly proud of their Inka heritage which is electrically still present in their blood and the genuine love for "pacha mama", Mother earth. Maybe it's just that I haven't traveled enough, but I have never met people more in touch with nature. It didn't take long to understand that people in Cusco and the surrounding sacred valley live and die for the earth. It guides their every move and is the underlying reason in their minds for how their life unfolds. They believe that the wind can take lives as she wants, and they don't question it. It's amazing to me to be able to believe so wholeheartedly that way of life. I wish more people here adopted something like this to believe in. While I know that people there, like everywhere else, long for more money and a "rich" lifestyle, I was moved by the large number of people I did meet that were perfectly happy with their simple lives in the mountains. It was very refreshing for me to see that and a good reminder of the wasteful, materialistic lives we live here in the states. It was such a humbling experience to share their culture.

Overall, I met some amazing people, pushed my limits physically with the hike, and really engulfed myself in the spirituality that is all around in cusco and macho picchu. I'm home now with a new perspective and goals to return to Peru very soon! :)

Here are some pics:

Initially i thought I could cross Peru off my list. But after this trip, I realized that I added abut 5 more Peru trips to the list! Pictures don't do this magical place justice. Peru: nos vemos pronto!!! <3

Thoughts from the CCU...

2012-01-11T23:30:00.000-06:00

So it's pretty much over. The rotation dubbed, "the worse month of intern year"...is behind me!! Yay! Has it lived up to it's hype?? YES...and then some, or a lot. Mostly because we were intentionally understaffed due to the holidays thus making an already confidence destroying and soul sucking month 10 times worse. I guess they don't want to be the main reason for the exponential rise of depression in more than 4 unlucky interns around christmas. So, I got to be one of the lucky few to experience the CCU during the holidays, how privileged I am. :)

So what makes CCU so bad you ask???

Here is my attempt to describe, with random details, the essence of CCU.

1. Cardiologistss obliviously speak their own language that nobody really understands, unless you too are a cardiologist, and even then its questionable. They presume that interns can speak cardiology the instant they graduate medical school. I mean, of course, how dare I have difficulty following what you're trying teach me right now...I'm clearly slacking since in my long 6 months of training, I don't know the intricate details of a subspecialty of a subspecialty of subspecialty lol. Shame on me.

2. Cardiologists actually believe that non-cardiologists, and possibly the rest of the world, can read their minds and know precisely what they are asking and what they want to be done. Don't forget that they are forever speaking in their aforementioned secret language.

Example:
The question they ask during rounds: "When did the patients chest pain start?"
What they actually mean: "I want you to tell me the results of every cardiac stress test, heart catheterization, echocardiogram, and cardiac labs were back 5 years. Oh, and what they ate for breakfast on their 15th birthday."

3. Cardiology is THE MOST evidence based specialty with hundreds, almost thousands of trials with stupid names like, "HOPE, MADE IT, SURVIVE, and BREATHING NOT PROPERLY"...seriously cardiology??? I have a hard enough time remembering the actual medicine much less the trials that proved it and how it was set up.

4. After listening to the various different ways "chest pain" can be described by the hypochondriac, psychotic, insanely old, blind and deaf, the guy who just wants to get out of his nursing home, the blissfully demented lady who probably can't remember she even has a heart, the 24 yr old kid trying to get out of the military, the cocaine addict, and the rare semi normal person that has actual cardiac chest pain, your idea that you actually knew what chest pain was, goes totally out the door. Bottom line: nobody knows what chest pain truly is, not even cardiologists though they pretend to and talk about all the different types using their language. Some days i walked away so confused about whether a person's chest pain was even in their chest. Other days my attending deliberated about the type of pain so much and went through all the possibilities and criteria that I wasn't even sure what a chest was anymore, or a heart for that matter lol. But seriously, after this month, when I hear/see the chief complaint of "chest pain" I have a feeling it's going to make me vomit or punch somebody in the face. Truth.

5. Congestive Heart Failure. Swollen testicles. Disgusting marshmallow people whose skin could potentially look like one of those egg crate mattress covers if you poked them enough. GIve lasix and wait for the urine to flow. More swollen testicles. There are no words to describe how much I hate congestive heart failure after this month. That's all on this incredibly boring and annoying aspect of cardiology.

6. EKG's. Finally starting to get the hang of it. Or so I thought. That little squeak of confidence was destroyed when asked to break down every aspect of a "difficult" EKG (fyi- a stone cold normal EKG at times can be difficult for me lol) in front of the whole team including the eletrophysiologist (best EKG readers in cardiology by the way)
It sort of went like this..

Dr. EKG: Dr. Ramirez, what you've just said is one of the most insanely idiotic things I have ever heard. At no point in your rambling, incoherent response were you even close to anything that could be considered a rational thought. Everyone in this room is now dumber for having listened to it. I award you no points, and may God have mercy on your soul.

Me: Okay, a simple "wrong" would've done just fine.

(one of my FAVE movies ps)...But that's pretty much what happened.

7. Everything in cardiology seems to have like 10 different stages an subtypes and subgroups. For example: CHF stage C NYHA class III-IV grade II diastolic dysfunction. Do people actually know what that even means?? Really??? You might as well say CHF stage furry class 5 subgroup 6 subtype 13 grade yellow. I mean I learned it and all. But so annoying. I prefer my patient's version of classifying her husbands end stage heart failure, (in VERY heavy korean accent) "He hart no wor so good". So much easier.

...so as not to sound like the month was all bad, here are some last good things about CCU

8. You can actually burn a line i a certain area of a persons heart with an arrhythmia and it beats better. Thats just pretty cool. Seems counterintuitive, but it works. THose really good EKG readers are geniuses.

9. You get to electrocute people on purpose, with their permission. Also pretty cool. I noticed that I was actually really interested in the electrophysiology aspect of cardiology, more than I expected really. I usually don't like things having to do with electricity, but just the idea of the heart, floating in essential water, can have electricity flowing through it making it pump sort of blows my mind. If the heart can do it, i think we can find a way to make iPhones water resistant so I don't have to replace my phone so often. Seriously, get on it apple.

10. Learning stuff. I didn't think it was going to happen this month. Interns are mostly worker bees. We do as we're told and even if we do have an idea or plan or voice, it's usually ignored. That being said, i never had any ideas of plans on cardiology in the beginning because I had NO IDEA what was going on and what I was even intending to talk about (like the patients chest pain). Not to sound utterly clueless, but cardiology is such a specific specialty, you'd be a food if you thought you actually were good at cardiology prior to intern year or even during intern year. So considering that my initial knowledge of cardiology was close to negative ranges, I feel like I did learn a lot and could possibly be approaching about a 2 or 3 now...on a scale of about 827364872648762387. But seriously, i did learn and even got a few pimp questions right from time to time. And the best part of all, aforementioned genius eletrophysiologist guy that I was pretty much afraid to even look at for fear of my life gave me surprisingly good feedback on my last day. He even told me that he thinks I could be a cardiologist if I wanted to. He crazy. Or maybe he's doing the secret language thing again and that's just code for "you're a dumb silly girl."

So it's over. FINALLY. Can' say I enjoyed it, can't say I hated it. Actually yes I can. I hated it. BUT....i did learn a few things along the way and I'm always grateful for that, it's never time wasted. Looking forward to a more normal life now.

I'm off to Peru. To find balance and perspective again.

Ready for a break...

2012-01-05T12:52:00.000-06:00

It has been a tough holiday to say the least. I hasn't really felt like a holiday even happened to be honest. I'm not complaining really, it's just a different feeling to know that xmas, my favorite time of year because of family time, came and went without event on my part. I could see everyone around me enjoying holidays and it just felt like I wasn't a part of it, what a weird feeling. But, i guess I knew this non-holiday holiday would come eventually. And overall, it sucked a lot, but now its over. It's the new year already and it feels like just another day. 2011 was one of the best years ever, and in some ways, the worst. The good made up for the bad and vice versa I guess. I don't really have big plans for this year in particular. I just want to live as much as I can doing the things that I've dreamed of with people that love me and do all of that without regrets. Doesn't seem that difficult...we'll see.

Anyway, i have 1 week left of CCU and it feels amazing. I can honestly say this has been the most challenging rotation of the year. Challenging in the sense that the work load has been ridiculous. It hasn't all been bad though. The days when i can barely keep my eyes open, those days are bad. The days when, because of the crazy work load, i feel like I can handle complicated patients way better than I could just 2 weeks ago are pretty awesome. Cardiology is actually really fascinating to me and if the schedule wasn't so nuts, I would consider doing it. But i'm perfectly happy being a cards geek ER doctor :) I've learned a lot and for sure still have more to learn all the time. It's been the kind of fun that i'd rather not do again lol.

Now that CCU is almost over...it's time for PERU!!!! I still can't believe that this whole thing is even happening lol. We literally came up with the idea totally not thinking it would be possible on such short notice...but here we are, 1 week away from flying to Lima. I'm so happy that it was able to be done, maybe some higher power had something to do with it because I've really needed it. After the tough holiday, tough relationship ending, tough work schedule, i need to go to a spiritual place and find perspective again. It's so easy to lose that while working all the time in an unhealthy schedule, seeing people at their worst all the time, and being around what seems like a constant stream of negativity from other overworked doctors around you. It's funny how we go to places far away from what we know to really find ourselves, there's definitely something to be said about that.

7 Days!!! :)

2011-12-27T21:01:00.004-06:00

One of my favorite people sent me this quote today...so very true.

“Destiny is a curious thing. It doesn’t always take us where we want to go, and many times ends up taking us to an unexpected place where we feel confused, lost, with no idea where to go next. These are complicated and painful moments that make us suffer and question who we are, along with what we want the most in our lives. But if we really make the effort to see these challenges as opportunities to find ourselves, we will understand that it was exactly what we needed to discover and strengthen our role on this planet.”
[rickymartin]

peace

2011-12-17T22:33:00.000-06:00

Source: Uploaded by user via Sherry on Pinterest

I needed this today.

Very exhausted.

More later....

What an amazing day!!!!

2011-12-15T00:20:00.000-06:00

If my life was written as a book, (a ridiculous, crazy, emotional, weird, etc, book) Dec 14th 2011, this day, would no doubt be a very important page.

Today I found out that I will finally start my training in the field of emergency medicine at San Antonio Military Medical Center. It still sort of has not sunk in that this will actually happen in about 6 months. Although at the end of the day, I'm here, right now, exactly where I want to be, there have been times where I felt like I would never see this day.

Sure, it possibly sounds dramatic. But aside from the underlying blessings of my own health as well as the overall health of my family, I've had days where I felt the opposite of blessed. Such days include the day when the Air Force revoked my medical school scholarship because I didn't actually get into a medical school in 2006 and proceeded to station me at Holloman, AFB in buttcrack, New Mexico to do fix airplanes. Also going down in the books as an equally "my life is ruined" day was the day when, after telling them I wanted to continue to pursue medicine, my own squadron commander and Air Force Headquarters ("The Man") told me, in not so many words, that now that I was a aircraft maintenance officer, going to medical school was not part of my life plan anymore and that I should proceed to accept the facts as a proud military officer. Both of these epic days sprouted many other epic days that just made me really feel like my dreams were dwindling away with every day that passed.

It's pretty crazy to think back to those days and truly understand how I was able to look past all of the negative feelings of despair and not allow myself to be discouraged by the obstacles that, at the time, were everywhere I turned. I don't think I'll ever really know how I did that. I guess it's just one of those things that you don't really think about, you just do it. I remember like yesterday wishing and praying to God that if he would just help me get to this day, I'd never ask him for anything else. I remember so vividly the feelings that time was passing around me, taking my dreams of being an ER doctor with it.

That being said, it's still so surreal to me that I'm even typing this post right now. I've been fighting against everything and anything to get to this day that now that I'm here, I have a hard time actually believing it. I'm not implying that I've grown up living the life of hard knocks or anything silly like that. Simply that nothing in my life has ever come easy. I feel like i've spent my life struggling and fighting against to get here, to this day. On the days like I talked about before (opposite of blessed days), there was nothing more that I wanted than to be finished fighting for "this life". But now that I look back, I feel like days when I felt like God or whoever had forgotten about me, were the days when I actually gained the most. It sounds all touchy-feely, I know. But no matter how many terrible days I have now, or how many times I think about how "tough" this life is right now, I look back at those days, remember how opposite of blessed I felt, and immediately realize that those were the some of the most influential days of my whole life. And without them, this amazing day, would not be nearly as meaningful.

So I love today. I love that I finally feel that some of my hardwork has paid off. But what I loved the most, was the feeling I got when I read my email telling me I was selected for Emergency medicine at SAMMC. I LITERALLY felt like the moment I read those words, the 200lbs, ever-powerful backpack of doubt and fear that I had been carrying around for a loooooooong time (even in my sleep, not just since last year) just disintegrated into thin air.

Overall, what an amazing day. I'm definitely going to bookmark this day and come back to it multiple times just so I know it actually happened.

Source: lifeslittlepresents.blogspot.com via Sasha on Pinterest

distractor post

2011-12-12T10:14:00.004-06:00

It's match week!!!

I'm working furiously on Peru adventure planning to keep my mind off the match. I've narrowed down my flights, buying them this week!!! Hopefully booking an adventure tour that involves hiking the Inca trail..also this week! You would think all of these things would distract me from the match. (wrong) I have self diagnosed ADD so it's VERY easy for me to jump back and forth from thought to thought.

So very excited about this trip.

Other things to distract me this week: my cousin time I'm getting, the ever present ambulatory care, working out?, online xmas shopping, etc.

Ahh it's match week!!

ok, i'm done now, even this post can't distract me :(

Random thoughts...

2011-12-07T20:39:00.001-06:00

As you can tell (or maybe not), I'm in the process of redesigning the blog! Actually, i'm not redesigning it, my cousin, the Xio part of XioKat is doing it for me :) Visit her blog and website, buy they're stuff, its awesome! I'm hoping redesigning= more posting, we'll see!

Thanksgiving break was great. I got some much needed rest and time to see family. Sad that I'll be here for xmas, working, overnight, on my birthday, in the CCU, hell on earth. Wish me luck and prayers that I stay sane :)

I don't even want to mention the upcoming (6 days) Air Force residency match that will determine my fate for the next few years. Lots of worst case scenarios going on in my head. I don't think its normal to be simultaneously looking for places to live in San Antonio, TX AND Okinawa...such is life. Bring it on AF!

To celebrate and rebalance myself after this ridiculous match business, I'm planning on crossing an item off my bucket list very soon!!! Just sent in my leave paperwork to take an amazing trip with a very great friend to Cusco, Peru and hike the Andean mountains of the Urubamba valley up to the incredible Machu Picchu!! I can't even get over that I'm typing this because this has been a dream of mine, literally, FOREVER. Let's hope the AF comes through and I can overcome the mounds of computer training and jump through the obligatory hoops the silly AF requires me to do. Again, bring it on AF, your antics are NOT getting in the way of this. *side note: this trip will result in me having to do 4 months of wards straight upon my return, yes, i said 4, yes that's going to be insane. Who are we kidding though, it's Machu Picchu, it's worth it! And when do we ever get to travel like this? I'm doing it. :)

I bought those silly five finger shoes. So far they're awesome but incredibly different and will take some getting used to. I ran today in them, maybe more than I should've. Feet are hurting now. I think if I can adapt my plantar fascia will like me again. Updates coming.

My cousin, from Colombia, is visiting me tomorrow for a little over a week! Very excited. She's a future doctor and awesome.

Currently on an outpatient internal medicine clinic rotation. It's quite boring/annoying. I don't care about pulmonary function tests...or diabetes follow ups. I DO care about short days and weekends off. So no complaining here. :)

...that's enough random thoughts for now.

Oh hey there Machu Picchu....

Sometimes I wish...

2011-09-29T22:57:00.001-05:00

...that I was perfectly content with being a housewife and that I didn't care about the whole saving lives thing. I say this almost weekly, but really, who am I kidding?? With my domestic skills, I would make the world's most terrible housewife and my family would prob pay be to go back to work. It seems like it would make this life easier some days though. Until I realize cleaning and laundry stresses me out more than a crazy ER full of dying people. Maybe in another life.

...I was more girly. I've NEVER been an actual girly girl, as most of my friends have often told me. I've always been known as the tomboy of my family and I've actually gotten much better, thanks to my cousins :) I own actual high heels and dresses, several actually. This is an improvement from just a few years ago. I'm pretty content with my girlyness, or lack thereof. But sometimes, and by sometimes i mean once in a blue moon, I get the urge to wear dresses and high heels but then I quickly remember the trauma i have experienced from wearing high heels and my high heel PTSD comes back. Oh well, I'll stick with my flats out of respect for my feet, they do a lot for me as it is. :)

...I wasn't so stubborn. (this is not likely ever going to happen) Being stubborn isn't always a bad thing. It is part of the reason I've accomplished most things in my life. But sort of like the housewife thing, being less stubborn and more able to accept things I can't change would again, make this life A LOT easier lol. I guess it comes with the territory of being my mothers daughter. I never give up on anything. I often struggle with understanding that giving up isn't synonymous with walking away. Sometimes we just have to let things be and realize that, in my mom's own words, "cant save the world everyday." Let it be. Maybe a new tattoo idea?? ;)

...I had a longer attention span. My presumptive ADD sort of conflicts with my need to learn things for myself. I genuinely have to look up everything I'm taught, despite where/who I hear things from. Not in a distrusting way at all, I just always feel better reading things for myself straight from the source (i promise i'm not crazy controlling freak). I believe we should trust, but verify. That being said, I really have to work on my attention span. I go to read an article or a chapter to verify what I was just taught for example, and I can't make it through the 3rd page before thinking about what my next meal is going to be, how far I'm going to run that day, or some other random non-important thought. I need to get a grip on this attention span thing...intern year is not the time to get distracted by every car that drives by lol. I feel like that dog from Up...sqquiirrll!!!!

ok I'm done now. There's many more things I could add to this list. Sadly, that last one is the limiting factor. Off to sleep.

This might actually be my wedding attire, one day, except red instead of purple... :) :)

Source: ninephotography.squarespace.com via Bix on Pinterest

I get to Starbucks before it opens :(

2011-09-11T20:21:00.002-05:00

Not to be insensitive at all, but today I kept seeing facebook posts and even hearing people say "never forget". And shamefully, I'll admit, I had no idea it was Sept 11th until I got home from work! :-/ Fail on my part as an active duty military officer. In my defense, I didn't actually forget, I just never knew what day it was, seriously. Crazy what waking up before 4am daily,12 days straight without a day off, and extreme fatigue can do to you. I live not by the actual date, but by how many days my patients have been in the ICU, I've been getting to starbucks before they open lately, and my attending has already told me to eat more for breakfast because my growling stomach during rounds is distracting... it's quite sad. lol

ANyway, MICU has been going well so far otherwise. One thing that I mentioned in my last post that has continued to be a theme of the month is death. Not because my we as a MICU team are bad doctors, but because it seem that this month we have been the terminal cancer service. In the past 2.5 weeks, i think only a 1 or 2 days have gone by where we didn't discharge a patient to heaven. Most were expected, a couple were not, and those were the rough ones, but not the roughest. THe roughest for me to get over are the ones that don't actual die. They stay "alive" but they're not actually living. I don't dwell or let it really get to me to the point where I can't do my job, but I do have to admit that I am sensitive to this aspect of medicine, always have been. It's a good thing right? I feel like we live in a doctor culture, especially in the military, where we frown upon sensitivity. We are people, not robots no matter how tough we pretend to be. I bet even the big tough surgeons who puff their chests out all day long pretending to be big and bad get a little sad from time to time. lol That being said about the daily death we have had this month, I have to say that there's a fine line between trying everything you can to preserve somebody's quality of life and keeping their heart beating until family can find the strength to say goodbye. I hope I don't have to ever make that decision for somebody I love. Either way, all I know is med school does a terrible job of introducing us what to do when you get the call "Mr/Mrs. X is just passed, come now, the family is very upset"....yikes!!!

Anyway, that's depressing. In happier news, next month I will have a life again! :) Things I'm planning on doing:

- Step 3 studying...only because I HAVE to
- Celebrating the fact that this crazy schedule that Tim and I have had due to studying for tests is over!
-Thursday night group rides with king william cycling group!
- uncover hidden treasures in san antonio/austin
- find places to hike/rock climb
- have groceries in my apt on a regular basis
- take lots of pictures...of everything
- cook...a lot
- stay awake past 9:30pm

On a side note: Since my mom recently welcomed a beautiful Chinese exchange student named Maggie, I decided that I'm going to visit her, my new sister, in China and I'm making this (climbing in China) happen soon...no matter what it takes!! ;)

Source: onsight.com.au via Sasha on Pinterest

2011-09-03T21:31:00.002-05:00

Welcome to the MICU....

I've been in the MICU for 1 week now and it's been great. By great, I mean that I'm learning a ton and I love the work. THe last 3 days, 3 patients died...rough. I pronounced my first death, did chest compressions twice already, and had to give some pretty tough advice about withdrawing care. Everyone has said that MICU is the busiest rotation and that I'll never have time to workout. So far, i've had the opposite experience. Everyday that I come home from being surrounded by death and dying, i feel compelled to run and exercise. Maybe that's just my way of feeling alive and shaking off the emotional weight of the day, but it's become necessary. (my love handles are also benefiting from this lol). Anyway, MICU is rough but amazing to say the least.

Tomorrow will be 1 yr since Tim and I went on our first date. Crazy. Crazy that he has continued to ask me on dates for a year. Crazy that he has continued to put up with me during this year of unknowns and moving and changing of plans. I'm pretty lucky in my opinion ;)

Thing's that I'm not used to yet...

2011-08-30T19:28:00.000-05:00

1. This patient history: 22 yr old male with bilateral lower extremity below the knee amputations, right hand amputation, and blast injury to testicles and penis. (this kid is not a rarity sadly)

2. Being called doctor by above patient and him thanking ME for my service....are you serious??!!! I have done nothing compared to the sacrifice and decisions these kids make everyday.

3. Realizing that I'm not a med student anymore and my signature actually means something now (mainly, I have a licensee to kill)

4. Waking up at 4am daily...and wanting to go to bed at 7pm

5. Being far away from Tim and seeing him once every 2 months :(

6. Knowing that my holidays will be spent in the hospital this year

7. Feeling like all I do is work and sleep

Source: None via Sasha on Pinterest

My path from A to B is quite similar to this. Doing my absolute best to enjoy this round about path that seems to be the theme of my life. :)

It's 7:22pm. Bedtime.

Deja Vu, I hate you.

2011-08-11T01:17:00.000-05:00

So before I start this post, I want to note that I just read my previous post and i really don't even remember writing it! Totally serious. It was a good post, and I'm glad I wrote what I wrote, but I honestly don't recall writing it. This post on the other hand, I wouldn't mind forgetting...

Today was my day off. What did I do today?? Here's a list of the progression:
1. Got a hair cut
2. Spent way too long re-writing my CV while drinking Starbucks and people watching [ps-why does it feel like always have to re-do my CV but I never feel like I actually have done something awesome enough to make it better???]
3. Watched my new tv obsession, "I Shouldn't be Alive" on Animal Planet and got lost in my thoughts about how I would most likely die in each of the situations presented in the episode.
4. (Feeling guilty about watching tv): rode my bike to Mad Hatter's Coffee and started writing my new personal statement for this cycle of emergency medicine applications
5. Had a moment of horrible deja vu and despair about the fact that this whoooole drawn out process that is the military match AND civilian match is happening again :*(
6. (frustrated with my negativity) rode bike to eat away my stress with sushi and somebody who really inspires me [you know who you are]

I usually think deja vu is pretty cool, eerie, but still cool. I HATED the feeling I got today when it seemed like all my stress of the match, not knowing (again) what on earth I will be doing or where I will even be doing it, totally came rushing back. I've been telling myself for the past year now that everything happens for a reason and this is where I'm SUPPOSED to be right now. But i guess I just can't help but let the weight of everything, including the powerless feeling this process gives me, overwhelm me right now. I know the right thing is to just relax and have faith that I'm doing everything, literally EVERYTHING, in my power to set myself up for matching in San Antonio this year. And I know the right thing to say is that, whatever happens will happen and things will work out for the best. I know that I can't plan everything (nor do I want to). And I know that I can't have back up plan B through Z when it comes to trying to end up in the same location with Tim.

It's almost painfully obvious that this is yet another lesson in faith and trust that it's all part of a plan. But I don't feel like any lessons today. We're all entitled to have our days right? THe days when we feel like we're losing our grip on things we thought we had strong control over. The days when we can resist what we know is truth only to be followed by a day of regrouping. I think today was my day to resist...and I successfully did that. Maybe tomorrow (i hope!!) is the day to regroup and move forward. .

PS-
I (not so?) ironically stumbled on this pin today...

Source: lilluna.com via Sasha on Pinterest

I love my job

2011-07-19T23:45:00.000-05:00

It's 11:21pm, I'm home blogging instead of working on a case report that is due soon, and I love it. It's my day off today and honestly it hasn't really felt like a day off. Nights have been going relatively well. It is crazy busy and I feel like I'm running around like a pager carrying chicken that just had its head chopped that's trying to find it's way around a hospital. After the first night of getting lost, asking nurses how to do pretty much everything, and figuring a small amount of things on my own, I feel like I have the hang of things. By the hang of things, I mean that I know where to find my patients in the hospital and can stumble my way through the calls I get from nurses. I haven't had anything too crazy happen just yet but last night was a close one. I came within a couple hours of having to pronounce somebody dead :( I was pretty sure she was going to die last night but she (or somebody else) kept her with her family for a bit longer. I talked to her family and prepared them for the end that was very much in sight. It was really tough. As a medical student I've seen very sick people before, but never on my own. I was never the ONLY person that was in the room with a family and their dying loved one. I kept her comfortable and just let things play out. I'm not sure if she made it through the day today, I guess I'll find out tomorrow. It just made me really think about how fragile we all are. Here one day, and gone the next.

But overall its going well, I can't complain. I'm learning a lot and I think I'm actually getting to closer to the day when I actually FEEL like a real doctor. One thing I have noticed that I hadn't really thought about was the amount of young, drastically injured people coming to the hospital for rehab. I see them as i'm walking into work everyday. On a daily basis I see no less than 5 kids wheeling themselves and their newly amputated stump around the hospital. WHen I see them all I can think about is everything that landed them here. The process from being wounded in theatre to being able to wheel or crutch around a hospital on your lunch break form rehab. I can't even begin to imagine the battles they fight everyday. So it does make me sad to see so many young people like that. But it does make me re-evaluate things when I get frustrated and feel overworked or tired. I'm incredibly lucky and I can't forget that.

I think it's pretty amazing that I get to experience all of these things for a living and even better, get paid for it. The hours are long and it's a lot of sacrifice. But in no other career would I be able to actually make an impact on people and truly give back as much as I do. It's a special gift to be able to be here and good or bad, I wouldn't change it.

Night shift= no sweat...literally

2011-07-14T23:25:00.000-05:00

I'm starting my 2 weeks of night shift tomorrow! Contrary to what my colleagues have expressed, I am very excited to start! This out of proportion happiness is probably due to the fact that I'm just so anxious to start being a doctor already, a real doctor. Not that 2 weeks on nights makes me a "real" doctor by any stretch of the imagination. I just really want to get out of this holding pattern I've been in during these past 2 weeks of "research" block. (I mean really, how can I do research when I haven't even seen my first patient of my medical career???)

So I know nights is going to kick my butt in more ways than one but I'm actually very ready to start learning the real things that doctors do. I'm ready (I say that now) for the 3am call about a patient who is having chest pain and needs help. I'm ready to frantically run my little intern feet down the hall to a code and immediately realize that every ounce of medical knowledge I thought I had suddenly disappeared and I have absolutely no business being part of a code, much less running one! I feel like I'm ready for all of these things! Oh and just for the record, ready does not mean prepared. I'm fully aware of how unprepared I am to manage the needs of every and any medicine patient in the hospital at night. But I do think that it's more important to be ready than prepared in certain situations. For things like crazy night shifts and running codes that not only take you out of your comfort zone, but destroy any last memory you even had of feelings of comfort, there is no amount of time that could prepare you adequately. I have this feeling, and I've been told, that it's just one of those things that you have to go through to fully understand. I guess it's like the whole "you had to be there" jokes. Except I highly doubt I'll be laughing, maybe, who knows.

The things that I'm putting in the "bright side" category about night shift:
   -no waiting at the BAMC gate for 3x the amount of time it took you to actually drive there
   -no extra people (i.e. interns, visitors, random people that just get in the way) around to worry about
   -the lack of extra people will decrease the number of people that see me screw up!
   -The cooler temperatures during which I will be leaving. No sweating on the walk to the car, yes!!
   -The "learning experiences" I will get...*nervous laugh*

...and that's all I can think of right now. This list surely decrease starting tomorrow as I'm sure I will only see fewer bright sides (literally) after my first night shift.

Off to continue my quest to stay awake as long as I can and sleep all day tomorrow. (so far I'm failing miserably!)

I hate Blues...

2011-07-11T16:20:00.000-05:00

Today was Monday...It's "Air Force Blues" day where we're required to wear the dreaded uncomfortable blue uniform. I felt a little on the blue side today for a few reasons. I guess I was just following the blues day theme.

I start night float on Friday. I'm pretty excited to finally start working and get out of this holding pattern/psuedo research block i've been in. I'm also pretty scared that I'm going to be so overwhelmed and not know what i'm doing. I'm not going to be alone, but even with help there, i hate feeling like/being an utterly clueless doctor. It's going to be busy, no sleep, and crazy. Wish my patients luck!

Short post today (see paragraph 1). I'm off to visit a friend and eat some yummy Filipino food. That surely will mark the end of Air Force Blues day. (i hope)

2011-07-05T22:07:00.000-05:00

Source: None via Marybeth on Pinterest

The chase has...continued!!!

Weekend with Tim!

2011-07-04T20:50:00.001-05:00

I was one of the lucky ones to have start residency on a non-inpatient rotation. Not only is my first couple of weeks non-inpatient...it's actually a non-patient rotation...RESEARCH! :-D At first, I was bummed out that the huge build-up to internship felt a bit anti-climactic. My first real day of being a doctor didn't even require me to come into work! However, I am NOT complaining at all. It was a blessing that I was able to have the weekend off because my Tim was able to visit me! He arrived Friday night and we had a great weekend. I showed him around downtown San Antonio and King William. We spent most of the weekend on bikes making plans to live here in our own cute King William house. It was nice and I'm excited to see what the future holds <3. We rode around town, did Crossfit with some fellow interns (which totally kicked out butts!!) in their home crossfit gym (CROSSFIT EMESIS) they made, cooked ourselves a fantastic dinner, and just relaxed. It was a weekend that we both needed to put things in perspective again.

Now that the weekend is over I'm looking forward to really getting a study/workout regimen started. I have lots to do in these next 5 months and a lot is at stake. Residency, Boards, EM applications, fitness goals will for sure keep me busy and hopefully make the time without Tim go by fast!

Pics from the weekend...

Our vehicles!

Post-thai dessert: Tres leches cupcake and cheesecake

Dinner my Teem made for me!

Pioneer building in King William

Admiring homes in King William historic District

Dancing at a beer garden on First Friday <3

2011-06-27T22:04:00.000-05:00

Source: 1.bp.blogspot.com via Sasha on Pinterest

Sometimes we fall off...In my case, it happens a lot...just have to remember to check the breaks and keep the wheels turning <3

Home is where my bike is...

2011-06-25T22:42:00.000-05:00

I'm approaching my final week of residency orientation! It has been somewhat of a long 2 weeks full of paperwork, endless power points, safety briefings, and trying to re-adjust to being back in the Air Force. In-processing, the military word for checking in and starting at a new duty station, has pretty much been a painful experience for me. Mostly because something got lost in translation (i.e. my SSN-which is kind of a big deal) and made virtually every form I was supposed to have, every system that I had to have set turn out incorrect. Long story short, I had to do everything at least twice to fix the error in my SSN. BUT...it's ok, it all worked out and I got a 2 week lesson in patience :)

In other news, I'm getting settled! I LOOOOOOOOOOVE my apt..well...with the exception of the elephant wearing high heels that lives above me. It has gotten better over the past week. However, the first week I was certain the upstairs neighbor was practicing her runway walk promptly at 3am daily!!! Aside from that, the apt/loft is amazing. It's the nicest place I've ever lived in and it makes me feel like a real adult...scary. Not only is the place awesome, the location is great. King William is a very unique historic district with a great soul. There are several galleries, independently owned shops and restaurants and just a general alternative. It's not your run of the mill suburbia and that's what I love about it! Probably the best thing I like about this location is that I can (and do) ride my bike pretty much anywhere. Downtown is a 5 min ride, King William is 1 block over from where I live. In phoenix, i really only rode my bike with groups and when I was specifically training for races. I forgot how much I loved just riding my bike places, no real training goal in mind. For example, i rode my bike to get my hair cut last week after a very very long day of orientation. It felt so nice, other than the little fall I had, to ride a bit and "unwind" after work! Overall, in just a few short weeks, San Antonio has brought me back to my bike and makes me feel at home. I'd say that's a good sign!

So now that I have one week until I start and am more or less settled, life is better :) The interns and residents have been really nice and helpful so far. I know it's going to be a tough year in so many ways, but I can honestly say I'm excited and grateful. 1 year ago I was in San Antonio ironically. During that time I can remember feeling like I belonged here and praying that I would match here. Well..I did! (sort of...more on this later)This year, I'm here, and praying that I STAY here. I guess we'll find out soon enough. I mean, who would be more perfect for SAUSHEC (pronounced: SAW-SHEK), than Sasha! (prounounced SAW-SHA) I mean really...can it be more obvious that this is where I'm supposed to be!? ;)

Here are some pics from the past couple of weeks!

The outside/inside of my complex: South End Lofts

Waiting for a red light in Downtown :) (I'm an eternal tourist)

Houston St. and St. Mary's- sitting at a starbucks

"Beauty...it rubs against one's tongue

it hangs there hurting one. insisting on its own existence

finally it gets so one cannot stand the pain

then one must have beauty extracted..."

- this was something i saw on a ride home recently...it's pretty interesting, still trying to figure it out

My trainer!! (and makeshift riser lol) I love it! Now I just need a new bike for riding around town :)

Messy and a work in progress...but it's a start

Something I just realized...

2011-06-13T22:52:00.000-05:00

I need to re-do my collage above for it's annoying me. I'm not sure why. Maybe it's because some of the pics of Tim and I are stretched awkwardly and we look like fatsos.

Nothing interesting to speak of tonight. Just miss Tim a lot. I get to see him on July 1st!!! So that's great news and the countdown has begun! <3

Orientation starts tomorrow!! (gulp!)

2011-06-08T20:52:00.000-05:00

Tomorrow the Air Force will attempt to orient, in 3 weeks, on how to be a doctor...yikes! I'm sure it's going to be a lot of briefings and trying to stay awake while they try to explain things that should only take a few minutes, in 3 hours. Nonetheless, I'm happy to get started! I'll let you know how it goes! In the meantime, this is me:

Fast forward 4 months!

2011-06-07T23:05:00.000-05:00

In my last post, I was in a different country. And now, now only am I back in the USA, I am calling a NEW state, TX, home. LOTS has happened (i always say that) in these past 4 months, here is a list:

- Was blown away by my awesome seester's BFA show and her work--> she is incredibly talented and I really admire her creativity and how she's following her passion.

- Graduated from medical school--> Was so happy to have my family and Tim come all the way to Kirksville, MO to share this special day. We didn't go to pricey dinner or have a crazy party. But we did spend time together, and that is more valuable to me than anything in this world.

- Became a Captain in the Air Force--> I can really get used to being called Capt Ramirez ;)

- Saw my little brother graduate high school--> I'm so proud of him! He has grown up to be such a good boy/man but he will always be my little brown boy.

- Went to Puerto Rico with my family and my Tim :) --> Beautiful place with my favorite people in the entire world.

- Moved from Phoenix to San Antonio, away from Tim :( --> A very bittersweet day for us. But I know the greatest things in life are not always the easiest and everything happens for a reason. Hopefully this will make our relationship stronger than ever.

- Started to process of planting my feet in Texas :) --> This is sort of a work in progress. I already know I love San Antonio from being here several times before. Moving in to my new place next week will be the next step. I'm so excited to design my place and explore and really make San Antonio my new home!

So, HUGE milestones going on and as always, it feels overwhelming, exciting, scary, and crazy all at the same time. It's tough to describe how it feels to be here, at this point in my life. One one hand, it's a feeling of relief and accomplishment, of, "wow, I'm DONE. I finished 20 years of school!" It is an accomplishment that is surreal still. On the other hand, I feel like things are only just beginning! It's sort of like a long, yet amazing, introduction to, what I hope will be, an equally incredible and fabulous story!

The excitement I have for this next step and all of the steps to come is also tough to describe. It's almost like this is the moment everyone was talking about when they ask, "what do you want to do when you grow-up?" I'm grown up, it's happening right now (somewhat), but my answer to that question seems like it went from doctor, to doctor + a million other things! I have so many things I want to do in life and now that my introduction has been written, I can finally start the real story.

Here are some of my favorite pics from the past few months :) More posts to come soon!

3 days left in Colombia :(

2011-02-24T16:55:00.000-06:00

My month in Bogota is coming to an end and I´m torn. Part of me really wants to stay and experience more, but the other part of me can´t wait to get home! I turned in my white coat today, the hospital gave me one to use, and I´m basically done working´now. The past couple of days I was getting REALLY tired of kids with gastroenteritis, so I think its safe to say I was ready to be done lol. All in all, im happy that I got to coem here and learn in a different system. Fundacion Santa Fe is actualy only a very very small picture of what the medicine in Colombia is really like though. It very much resembles the US in terms of EMR, medical resources available, etc. If i could do it again, after already experiencing FSFB, I would want to do EM in a not so nice hopsital in town that gets trauma or at a rual health center in one of the surrounding small towns. But that´s def later, once I have a few years of being a doctor under my belt lol. Maybe one day... :)

Anyway, now that Im almost gone, I´m starting to think about where I want to visit next. I know craziness (intern year) is going to start soon in June and I wont really have anytime, but I´ve decided that I want to always have travel plans in the works. If not now, then when will I ever do it? Its all too easy to say theres no time. ANyway, I would love to come back to Bogota with Tim and show him how amazing it is. I also have really been wanting to go to Brazil lately. My cousin was there for 6 months and, although I already have been wanting ot go for a looooong time, the way he talks about it is just making me want to go even more. Also, #78 on my list of 200 things I have to do before I turn 50 is: learn Portuges!!

In other news, now that i only have a few days left, ALL of my aunts want me to see them. Theres too many aunts and family and not enough time :( I have gotten to see a good fair share of family though since ive been here and Im happy about that. Everytime I come to Colombia I meet more cousins and I love that. I dont think you can ever have too much family, even if they are somewhat crazy or weird lol.

what else...Ive met some pretty awesome people here at the hospital too. I think I work pretty hard, but Im constantly amazed by how hard the med students work here. They are brilliant and juggle school, research, traffic, and life in Bogota (which can be tough at times). I can honestly say, they work MUCH harder to be doctors than most american students do.

ok, now Im off to make the bes tof my last 3 days here!

Week #2 in Bogota!

2011-02-13T18:45:00.000-06:00

Time is really flying! I cant believe its already the end of my second week in Bogota! I feel like I just got here. This week was good. I am mastering the flow of the ED and learning the different quirks of the different docs/nurses (i.e. some like notes in a certain format, some don´t let me write notes, some want me to do everything, and some nurses get offended if I put a pulse ox on a kid without asking them to do it, very ridiculous, I know). Im also mastering the art of gaining weight! I´m not dieting while Im here but I have been trying, and failing miserably, to eat small portions and work out. Its not that I eat all the time (almost), but the food here is very heavy. Lunch always is some sort of meat with rice, potatoes, some other carbs, etc. I know its not the best, but I cant resist it!! ALso, if you dont clean your huge plate of food here, ive noticed tha tpeople look at you weird, like you are wasting good food. Im trying not to think about it and enjoy everything here, but I feel like a lard. I havent worked out in 2 weeks and that makes me feel more tired! Its sort of like the lady from the movie eat, pray, love, who has to buy herself some "big lady pants" after 4 months in italy. Im almost to the big lady pants point in only 2 weeks!! yikes!

In other news, walking home has been awesome this week! I figured out a faster, although initially more dangerous, route home. By more dangerous I mean I have to cross 2 really busy streets and a railroad track, and then its all sidewalks. Everyday to cross the initial 2 busy streets people (including me, but I let them go first so if anybody gets hit its them) have to sort of step right out in front of cars hoping they will stop. Nobody has gotten hit since ive been here, so Im assuming that tactic is pretty much the norm and cars are used to it by now. Nonetheless, i still get a little scared. After that though, the rest of the walk is side streets that take me through the mall and straight home. There are lots of cute stores on the walk home that Ive stopped in. Theres one, Inkata Design Store, that I really love. There are stores all over Bogota and theyre awesome! THey also have a really awesome outdoors store on the way home that I have yet to stop in because Im waiting until I have time to shop and buy things :) Ive also tried almost every coffee place (which is probably about 15) on the way home. The biggest coffee store here by far is Juan Valdez. Its the equivalent to our Starbucks, only better and they sell clothes! Its funny because at home, pretty much nobody would be caught dead wearing starbucks sweatshirts or jackets. But here, everyone wears clothes from juan valdez and its def in style!

THis weekend was super fun. I hung out with my cousins, went out one night, and explored the downtown area of Bogota. Some people say the "Centro" (downtown) is really dirty and ugly but I thought it was awesome! There are lots of homeless people around thats foro sure, but what downtown doesnt have those? The only difference between these homeless people is that they have no problems walking right up to you while youre sittin goutside having coffee, telling you a crazy story and asking you for money. THey will literally sit down with you until you give them money. After the 5th one, it gets really annoying. But the downtown is really artsy and down to earth, I loved it. Full of museums and really cultural places. I prefer that waaay more than ritzy parts of Bogota. I went with my cousin Mauricio, we were both sort of hung over from the night before lol. We called it the hangover trip!

I got a little sad today because I realized that there is soooo much more I want to do and see in Bogota and I only have 2 weeks left! I want to take a bike tour, go to more places with my cousins, go into the mountains. I know I wont be able to do it all while im here this time. :( I wish I didnt have to work M-F and I could have more time to be on vacation! But I guess Im technically here for school. I have a feeling though that Im going to keep coming to Colombia for a looong time. Everytime I come here I want to come back more and more. Just have to make time for it somehow once I start working.

ANway, it was a great weekend. More posts to come...

First week realizations

2011-02-04T21:08:00.000-06:00

My mid morning snack today :)

So Ive been here for 1 week now and everyday I´m getting a little more comfortable! I´m finally seeing my own patients and its awesome! I spent the first 2 days more or less shadowing the docs and "interns". I was really frustrated at first because I wanted to have the same productivity and initiative that I usually have but I didnt really feel comfortable´presenting a patient with the proper medical terms, nor did i even have the slightest idea of how to use the computer system. I didn´t really get an orientation or at least a "this is how things work" talk lol. I showed up, everyone said hello and welcome, and i was just ready to go :) Im getting the hang of everything though, even the crazy confusing program they use for notes lol. I made myself a little template of the proper ways to present a patient and write a progress note, without sounding like a gringa (aka white girl) Also, its tough to understand people because they speak SOOOOOO FAST!!! I can understand 99% of spanish but when they speak so fast I just stand there like, "ummmm.....huh???" But its going really well overall.

After 3 days of taking an hour to catch a taxi, fighting wiht people over taxis, getting ripped off by taxi drivers (they like to drive in circles to charge me more because they know im not from here and have no idea where im going), and getting lost in said taxis (here you have to tell most of them exactly where to go, the address isnt really enough for the ones ive been in), I decided to walk home everyday! :) My family told me it was pretty far but when I walked it a couple fo days ago its pretty close! Its only about a 25 minute walk at a godo pace...but it takes 40 mins for me because I take pictures of everything. Its even nicer for me because I dont mind walking through the city and I can stop and get coffe, shop, etc on the way home.

I was talking with a couple of the interns today about the differences in their school vs. ours. I´ll try to explain. They go to high school, and go straight into medical school. The medical school is 6 years, the first couple being classroom oriented, and the last years are rotating in hospitals. Then they do 1 year of internship, which also consists of rotating through all of the specialties. After internship, everyone who wants to practice medicine in Colombia MUST do 1 year of rural medicine in a small town. This is required to get liscensed in Colombia. After that year is when they can apply for residency here. SO, eventhough they dont do college, it ends up being pretty much the same amount of time spent to become a doctor, excluding residency. One huge difference here is that they have to pay for internship and residency themselves! So basically, they dont get paid until they become attendings...i found this crazy at first. How on earth do they pay for school and residency without ever getting any type of salary or anything?? There are some ways to get loans but basically, you have to have money to become a doctor plain and simple. When I first heard this I thought: In the U.S, NOBODY (well not me anyway) would be a doctor if we had to pay our own way through med school PLUS residency!! The difference is this: the cost of their entire training, including residency, comes out to be approximately between $80-90K. That is less than HALF of what med school costs for us!! SO, in actuality, its not that bad. I just cant imagine working for a hospital, with intern hours and the 36 hr shifts they pull here (and in the US, despite new rules limiting hours) and not gettign paid. It seems like the hospital is totally taking advantage of the interns and residents, its crazy. But that's the system. Some people love it and stay, and some get leave to the U.S or other countries.

Here are some more random things I found to be really interesting:

- Metronidazole and other heavy anti-parasitic meds are given out like water here! A parent can actually call a pediatricians office and say, "my kid has belly ache and diarrhea"...and they will give you Metronidazole without even seeing the kid. Reason: Amoebiasis is rampant here! In fact, tons of people walking around here have E. dispar (the asymptomatic amoeba). Its so common that people just go to a parmacy and by metronidazole and abendazole and use them at the first sign of a stomach ache. I just thought that was pretty interesting.

- They RARELY use CT scans in the ED. We've had at least 5 kids this week who 100% wouldve had CT scans in the U.S. to confirm appendicitis. They use ultrasound in 95% of cases in the ED. The only times they do CTs are when the surgeons demand it. Which surprisingly, itsnt very often. BUT, its possibly a good thing in peds since CTs are waaaay over used in the US and ultrasound saves the kid the radiation.

- There is one day every 3 months whare cars are prohibited and only taxis, busses, and handicap cars are allwed on the road. There a really big emphasis placed on improving the air quality, the environment, and healthy lifestyle. So, that one day every 3 months is very cool because everyone either walks, rides a bike, or takes taxi/bus. My cousin said that just 4 days per year of eliminating cars has improved the air quality by something like 20%. As cool as it sounds, I doubt the states could ever do that because its so big and spread out. Bogota is big, but everything is fairly close.

- New mom´s are give 3 MONTHS of maternity leave. I think thats pretty awesome.

Ok well, more stories to come soon!

Heres a picture

Just an Idea of the traffic here...

2011-01-31T20:47:00.000-06:00

This is only mildly exaggerated...

First day!

2011-01-31T20:43:00.000-06:00

So today was my first day and I think it was an overall success! I'm pretty sure I stick out like a sore thumb american, but I think I held my own. The morning started off with me not being able to find. Apparently I'm not the only one who pays for taxi's to go to work in the morning. Instead I had to flag down one of the taxis driving probably 70 mph (not kidding) on the street in front of the house. I had no idea how to get to where I needed to go so I really was praying that my taxi driver knew the address and could get me remotely close. The ride was rather interesting as the whole way there, which wasn't very long thank goodness, the driver wouldn't stop talking to me about how his wife just left him for a younger man and that he kissed her feet and she still laughed at him! Seriously, you can't make this stuff up. So as he's telling me about his wife and her new bf I quickly see that I'm close enough and ask to get out please! It was an interesting ride.

I got to the education building and after the mandatory purse check (this is required to enter any building here) I sat down with about 15 other med students and new residents starting rotations at the hospital. Talk about being intimidated! So after waiting in the group for about 30 mins I realized I needed to be in a different place since I'm an international student with totally different paperwork lol. Nevertheless, I figured it out and they sent me to the hospital to make the usual rounds: ID badge and White Coat. Here they don't allow me to wear my ATSU short white coat, they require us to wear the hospital emblem and a long white coat :) I feel special. Maybe its a preview of what it will be like a in few months! ANyway, I miraculously found my way to the ID badges. I did however, get so lost looking for the place where I collect the white coat (which btw is in a small grey seemingly abandoned trailer in the back of the hospital parking lot!). I'm pretty sure I ended up OFF of the hospital grounds, don't ask me how. BUT I got everything and finally made it down to the ED before noon.

THe doc I'm with is amazingly nice and awesome. She teaches a lot and has asked me to teach her as well. She wants to learn english so she'll ask me how we say common diseases. My first patient of the day was great, it actually gave me some confidence since I was pretty nervous about the whole spanish thing. I saw a little guy who's mom said she was feeding him, he rolled on his arm weird and since then he hasn't moved it. She let me examine him and I was pretty sure it was a Nursemaid's elbow, it was pretty obvious. The doc consulted orthopedics (which is a common thing here for anything even remotely related to orthopedics) and he found nothing and did nothing. SO, mom came back down and the doc let me fix it! It's no big procedure or anything, but it was nice of her to let me do that on my first day. Baby felt better within 10 minutes and everybody was happy, yay first patient!

The only other really exciting/frustrating part of the day was the trauma that came in. The kid was about 9 yrs old and he ran into a volleyball net and flung himself backwards and hit his head on the concrete at school. According to his mom he was fine for an hour and then started to drool and slurr his words, pretty scary. Side note: in the midst of the say, one of the other attendings (also very awesome) assumed that I was a 3rd year Peds resident, something clearly got lost in translation lol. SO, we're at this trauma and she says "go ahead start, I'll be right there"......ummm....WHAT?! Luckily my initial attending had already gotten there and everything was fine. BUt i seriously, in less than 2 seconds, panicked and started sweating through my clothes lol. Anyway, everything was going on and I knew what I had to be doing to help, but I was so oooo frustrated! I could barely understand what the doc was calling out because she was talking so fast! Also, traumas seem to be run differently here, so I was a little lost. But the most frustrating thing was that I just couldn't get my words out fast enough. I think in english, so it takes me a second to think about it all in english and get it out in spanish. Everything was fine, he got taken to CT (which btw i had no idea is called TAC) and he ended up being fine. But i was really so frustrated that I felt like a total idiot standing there in the trauma bay. I felt helpless and like everything I know is useless if I can't get it out the way I need to. I know it was only my first day, but I hated that feeling so much. I am getting the hang of it and training my ear to the Bogota accent. That feeling is another huge reason why I came here. I need to practice! The spanish I speak in Phx with the mexican people is VERY different than here. Anyway, that was my excitement for the day.

A list of some things that are different here that I think are worth mentioning:

- Med students wear long white coats
- nobody does undergrad, they go straight from high school to medical school (6 yrs)
- you actually have to pay for residency, you don't get paid
- nurses are called "jefe" (translation: boss) by everyone
- EVERYONE takes a full hour for lunch, even the ED attendings! (this I'm NOT used to)
- White coats are NOT allowed to be worn outside f the hospital
- Parents (for the most part) are very educated about what to do when their baby has a cold (waaaay more than in the US!)
- The docs aren't terrified of getting sued by everybody that walks in the door

More stories tomorrow and more will be added to the above list! :)

[BOGOTA]

2011-01-30T20:41:00.000-06:00

I'm in Bogota! After spending most of my 3rd year of medical school setting up this international rotation in Peds EM in Bogota, Colombia, I'm finally here! I don't even want to count how many awkward conversations I had with the department of education of the hospital where I'm rotating (Fundacion Santa Fe de Bogota). Trying to ask them if they would take me as a student, explaining exactly the documents I needed, translating said documents to english and vice versa, and apologizing for the infinite number of requirements from my university was extremely frustrating. Also, it's somewhat annoying when your own university doesn't even believe you'll ever be able to set something up in such a "dangerous" place. Nevertheless, I'M HERE! My rotation starts tomorrow, yikes! I've been in Bogota for just a day now and I'm getting more and more excited to start. I have some hesitations that make me nervous, mainly because of my spanish. I do speak fluent spanish, but my medical spanish isn't perfect. Living in AZ i've had so much practice and I've come a long way, but for me, it's still not good enough. I know (i hope) everyone will be very helpful no matter what, but i can't help but be a little nervous!

A couple people have asked me why I decided to come to Colombia, a place I've already visited several times in my life. Why not try for India or Africa (which I WILL do in my life guaranteed) or just someplace new????? The truth is that yes, I've visited Colombia before, but this is different than just visiting. It has always been a dream of mine to do medicine in different countries and really immerse myself in the country/culture. I chose Colombia because it seemed like the most natural place to start. Although I've been here several times, I have to say that I still feel like a stranger here. There are so many subtle cultural differences that, when put together, really make it a different world. I love that. I've always said that you never really know people until you've seen them when they're sick. Granted, I'm doing peds EM, but working here for a month in a hospital is going to give me a completely different experience that I've ever had here, I know that for a fact. The intention is not to go see the "pretty" things (although I can't skip some tourist things), but I just want feel the culture from a different perspective. I also want to see how medicine is practiced in general here. Based on the cultural differences alone, it should be interesting to see the differences in the ER alone.

I went to visit the hospital today just to look around and I loved it. I'll post pictures once I get more comfortable and know when and where it's ok to use my big camera like a tourist. It's in a cool, very business oriented part of the city. I have to take a taxi to and from everyday. It's cheaper since it's not far and just easier than taking a bus or walking.

I'm still not entirely sure what to expect or how tomorrow will go. My main goals for the first day are to just make a good first impression and not look like a total idiot. I'll let you know how it goes! :)

Residency post!

2011-01-30T19:43:00.000-06:00

When I talk about my match results (residency), i’ve had lots of people look at me with the “why is she so happy? I thought she wanted ER”- type of look. Anybody that knows me even remotely well knows how committed to emergency medicine I am. So, I understand the confusion going through my friends’ heads. The truth is that I was upset, quite upset when I first found out that once again, (flashback to not getting into med school first time around) it didn’t work out the way I planned and really really wanted it to...big surprise. I think I put so much weight on matching to EM this year because of how tough it was for me to fight my way out of a path that wasn’t in my plan (maintenance officer at Holloman AFB) in the first place and get back on track with my original plan for medical school! The LAST thing I wanted was to have to give myself the same daily pep-talk that I did when I found out I was doing the opposite of my dream in, what seemed like at the time, the worst place on earth lol. Everyday I would tell myself, “it’s not what you wanted, but it’s just an alternative route to get to where you want to be and no matter what, you’ll be better for it. Never give up”...blah. So I took not matching to EM pretty tough at first.

Oh and also, in my own defense, just to put things in perspective for non-medical students. Being in med school, surrounded by hundreds of other type A personalities that make not matching seem worse than dying a fiery death, tends to make the mere thought of doing something other than what you want totally UNTHINKABLE! For some reason, it’s equivalent to failing. So, we can graduate medical school and be in the top 1% of people but in our minds we’ve failed lol. Dramatic? Yes. Ridiculous? Absolutely. But that’s how we crazy medical students often think. And actually, that sort of thinking is what has actually brought us this far. But anyway, not trying to defend my craziness with this post.

So all that being said, my sadness over the match lasted only a day or so. I quickly realized, possibly because I’ve done this before, that all is not lost, not even close. Just because I didn’t match this year (to EM), doesn’t mean I’m never going to match into EM. Internal medicine is not something I would have chosen (obviously), but it is still a great year of experience that I can get under my belt. I’m in no way changing my mind about EM. Some friends in my same position have had a change of heart and decided to continue with the specialty they were given, and I’m happy for them if they’re happy. I’ve even had someone in a position of leadership in my school “politely” tell me that i should switch to a less competitive specialty so I have a better chance of matching again. (really?!?!?!) And honestly, that would make my life a lot more simple and maybe slightly more predictable. Fortunately (or unfortunately), it seems that it’s my plight in life to take the more difficult path. No regrets though, I wouldn’t want it any other way. I’m actually very excited to start intern year in internal medicine. I know it will only help me be a better ER doc in the long run. I’m trying really hard to look at from the perspective that I am still doing what I love! I'm still going to be an ER doctor that's for sure, but I know I'm going to love just being an intern. Sometimes I get so caught up in working towards what that “final goal” that I forget that life is happening right now. Sure I want to be an ER doctor that's very clear. But I'm not going to dwell what I did or didn't match into this year and not make the best of the opportunities the next year brings. I'm still going to be a doctor in an awesome internal medicine slot learning at a very sought after location. It's very cliche but very true, "Life is what happens when you're busy making other plans..." I highly doubt I'll ever be able to stop planning, but rather than looking at this match as a failure or short fall, I'm looking at it more as a previously overlooked opportunity and stepping stone to the next thing (ER next year!) :)

I'm extremely excited, very scared, and totally ready to start! I love the city, love the people there already, and can't wait to make it my home. And you already know that I'm going to find my way into that ED every chance I get!!

So that's my story and the long version of what I tell people when they give me the awkward stare when asking me about the match.

Updates :)

2011-01-30T19:18:00.000-06:00

It's funny that I've started my last few entries with something like: "it's crazy how long it has been since my last entry..." Well, to continue my theme, it's been 3 months! Actually, it feels like longer than that to me. Big things have happened since the last post! Just to name a few: I matched to a PGY-1 spot in Internal Medicine (see below) at San Antonio Military Medical Center :) , I got approved for my international rotation in Bogota at Fundacion Santa Fe de Bogota University Hospital (for which I leave tomorrow!!!), and I started a great relationship with an awesomely understanding and extremely sweet man that makes me very happy! So needles to say, things have been going very well for me.

Rather than try to post one looooong update post, I'm going to post a couple of long overdue posts after this one :)

It's November already!?!?!

2010-11-08T21:26:00.000-06:00

I really have been trying to blog more often, i swear I have. There are a hundred random moments during the day that make my mind go off on tangents and I tell myself, "oh, I can think about it more when I blog about it"...but that sadly hasn't been happening. Why? Well for starters, I'm easily distracted and when I start writing, i get up to eat and never return to my thought lol. But mostly, I've been crazy busy this month.

Last month was Toxicology which I LOVED!!! It wasn't busy, but I kept myself busy reading non-stop as not to feel like a total idiot during rounds and able to understand the genius talk happening around me. Also, not to mention I didn't want to fail the end of rotation exam, which, by the way was a success! I loved it so much that it made me really contemplate trying for the fellowship. BUT, i know it's incredibly tough and before I get ahead of myself here, I need to match into a residency first!

This month i've been on ICU at County Hospital and it's been awesome! The hours are long but I love running around being busy. Not to mention, I spend most of the days in the ED admitting people and sneaking away to watch trauma's come in :) Most people dislike the county hospital because it's pretty ghetto and also IN the ghetto. But this is exactly why I love it. The patient population is very different from the annoying stuck up scottsdale people. Our population is mainly lower-income people most of which are spanish speaking only. I love the humility, gratitude, and family bond of most of my patients. I've never met harder working or more grateful people in my life. This is not to say we don't get our fair amount of crazies, we certainly do! But i'll deal with the crazies and insane social issues for patients that will actually thank me everyday for my help, try to set me up with their sons, and invite me over their homes for dinner parties when they recover :)

So I've been learning lots the past couple of months! I'm trying to fight the common theme that students get "dumber" during 4th year. I can totally see how that happens though. It's easy to set your schedule up so you're not in demanding rotations that require lots of reading. I think the thing that keeps me going is the fear of internship. I'm not necessarily scared of being an intern, I know i'm going to make many mistakes. I know that in the beginning, i may not save lives, I'm just hoping not to hasten people's death, that's all lol. As expected, I've also had some really touching/disturbing cases at the hospital. Sometimes I wish i didn't speak spanish so I didn't have to tell a crowd of visitors their family member has cancer or is most likely going to die over night. I usually use running as a tool to sort of let the emotions i hold back at the hospital just melt away. But this month i haven't had time for that much :( I'm training for a marathon but I'm really behind. So some nights the stress sticks around. It hasn't been too bad, but I literally almost invited a patient to my house for thanksgiving dinner last week because I felt so sad for him. Anyway, it's been a great month so far and I'm loving it in all its ghetto-ness!

In other news, interviews! I actually have one tomorrow at the county hospital for prelim year and then another this Friday for emergency med in Michigan at Genesys Reg Med Center! This whole waiting for interviews and match is stressful, but I'm just happy to be offered interviews at this point! I'm sort of getting used to the not knowing where I'll be next year, this seems to be the theme of my life. I don't love not knowing anything past a few months, but I have faith that wherever I'm going, it's in the right direction and it will work out.

I'll finish with a few funny/cool happenings over the past couple of months:

-examining (trying to) a pt tweaking on meth and having her tell me that I have beautiful skin right before she peed on herself
-being told in less than 10s how to put in an a-line (arterial line) on a drug overdose patient and then actually doing it for the first time ever with no supervision
-being told by a charge nurse that I manage my pts very well :)
-handing a urinal to a pt and having him throw it right back at me
-breaking the doors that lead into the SICU (surgeons love that)
-charge nurse yelling at me for sneaking into a trauma
-knowing protocols for NAC (antidote for tylenol overdose) that my residents didn't know

Until next time...

Happiness hits you like a bullet in the back :)

2010-10-02T20:02:00.000-05:00

It's been a while! Over a month, times flies when you're busy/having fun/stressed/crazy :)

When I posted last I was still in San Antonio, TX and loving the ED and the idea of possibly winding up there for residency. I came back and jumped right into non-emergency medicine grind, the civilian residency application process, and the stress that comes with all of that. Yikes! So, September was a somewhat high stress month for me. Things that happened in September:
1. ERAS and other med student stress
2. Took care of mama after surgery
3. Got back to climbing and running (signed up for marathon)
4. Once again proved that test-taking is NOT my strongest suit
5. Once again proved that I'm not going to give up on emergency medicine
6. and many other little things...

It doesn't seem like much when I list it, but it was somewhat of an emotional month where I struggled with myself and had to prove my passion for pursuing my future goals regardless of how difficult it is :) More specifically, battling people who discourage others from pursuing dreams because the road is unknown and challenging. I don't work that way, as you know. I've proved lots of people wrong to get here, so it's nothing new to be told I can't do something...I just don't like hearing it. Eventually however, it serves as more motivation. So, now I'm sort of in a waiting period until December as far as residencies. Until then, I'm enjoying life and not letting a damn thing discourage me. I'll take life one day at a time and work it regardless of what happens!

Anyway, in other news, I'm going to Bogota, Colombia in February to work in a Peds ED at a hospital called Fundacion Santa Fe de Bogota!!!! It has been a LONG process to make this happen, but it will be well worth it in the end to do some international medicine, one of my biggest dreams! (especially with kids) Again, I've met resistance as to why I'm doing this, its so much work to set up. I've just resorted to telling people that I don't do things the easy way haha. It's sort of true. ANyway, I'm excited to experience how Colombia does medicine and work with local kids. Hopefully I'll make it up to the mountains and do the "doctor rounds" in the little town where my mom was born. A doc hikes up once every couple of weeks and makes home visits to the people that live up there, off the grid, living off the land. It's awesome, I'm excited! My last international medical trip was the most humbling experience of my life and put everything in perspective for me. I'm ready for that again.

So the past month has been packed with a lot of things! (like that's anything new lol) Although it has been up and down, I can honestly say that I'm extremely grateful everyday for being exactly where I am and where I'm going, although I'm not really sure of where that is. Just having faith that great things are coming!

More updates soon...

Things I love/hate...

2010-08-20T22:53:00.000-05:00

Things I've HATED (or just disliked) about this month:

- the politics of the military (i.e. useless paperwork, people making up stupid irrational rules to get promoted, etc)
- High heels in service dress
- Blues pants!! (who ever designed the blues uniform for women needs to be tortured, seriously. )
- my bathroom faucet that leaks every 1.5 seconds and I SWEAR gets louder at night and can be heard through a steel door!
- Having BMT kids stand up and at attention when i walk into the room in the ER. I know they're conditioned to do that, but i dislike it a lot. Same goes for the "yes/no ma'am" after every question.
- Seeing a little girl with "facial droop", making several glove balloons for her, and then finding out she has a large brain tumor and has less than 1 year to live. :(
- Having crazy enlisted people yell at me for a uniform issue while they neglect the things that really matter...like a patient with sats in the 70's!!
- The wasps (ugly black ones) that seem to live and multiply in my stairwell and chase me every time I need to come to my room!
- The smallest shower known to man, that also floods the floor with every use.
- Going for a run after dark and sweating so much that my shoes are soaked, gross.
- Wearing Blues on mondays!
- Whiney BMT kids that complain about everything and don't know how to cope with a little stress.
- cynical people, especially cynical doctors that hate their life!
- Nurses that think they're doctors
- blood on my boots :(
- Seeing a sexual abuse case on a 4 yr old
- Colonel's who think they deserve special and faster treatment in the ER and refuse to be seen by medical students
- Feeling like matching at this program would take a miracle because of my board scores :-/
- People who walk around with a chip on their shoulder

Things I love/hate...

2010-08-20T21:46:00.000-05:00

I'm almost done in San Antonio!! It seems like these past 2 months have gone by so fast! I've learned LOTS and made some awesome new friends. I hope I'm back here this time next year (fingers crossed!!!) THere are SO MANY patient stories funny, sad, and awesome from this month that It would take me forever to write about all of them. Instead I'll just list them in my love/hate lists...

Things I LOVE from this month:
- Taking care of basic trainees that are so pumped and don't even realize they've lacerated their faces in the field and are forced to come get sewn up by the MTI's, and when they arrive, ask not to be numbed up because they want to be "tough". Some of these kids are sooo pumped up about getting their asses kicked everyday...how can you not love them!
- Out of all the basic trainees that we see everyday in the ER for "lightheadedness:... basically being "wimpy"...90% of them are male! :-D
- Finding an acute appendicitis on a WWII mustang pilot! (and then sticking my finger in his butt, that part i didn't love, but how many people can say that?!)
- Convincing a resident to get a CT abdomen (and betting a cup of coffee that it finds something) and finding a weird congenital intestinal anomaly that required immediate surgery! (ok fine, maybe I was ridiculously lucky on that one, i just wanted coffee, but sometimes its better to be lucky than good!)
- Being part of an all female trauma team :)
- Finally grasping the concept that in less than 1 year, I will be a freaking doctor! (are you serious???)
- Being around people that understand exactly what I'm thinking without even having to say it
- Not being the only one who seems to have to know the age of everyone we're talking about, even non-patients ;-)
- Waking up to taps and going to sleep when I hear reveille :) I love the schedule of an ER doc!
- Being a part of a collective "yaay!!!" when the trauma phone rings.
- Learning that I too have my own "spidey-sense" about patients and even better, that a lot of times I am right!
- Not feeling like an idiot during a resuscitation
- Being pushed by residents/staff to be better all the time
- Realizing that i'm NOT the most type A person I know ;)
- Speaking spanish to my patients and having them tell me they are "proud of me." (i'm not really sure for what, but i just say thanks lol)
- Seeing people in the exact place/places I want to be and knowing the sky's the limit.
- Talking and Writing in only acronyms and abbreviations
- Hearing the words... "i trust you doctor"
- Looking at an ultrasound and actually seeing more than black and white dots!
- Sticking needles in things
- Having a consultant doc believe that I'm actually a doctor and not a med student!
- Being in a place where, 3 years ago, seemed so far away! :)

From Dayton to San Antonio...

2010-08-02T21:52:00.000-05:00

So I'm halfway done with my Air Force Rotations! :-) The Wright-Pat AFB rotation was an overall great time! I'm not just saying that because it is my first choice for residency, it really was probably the best rotation I have had yet. It wasn't a crazy county ER by any means, but I think that really had it's advantages. It wasn't so over my head that all I could do was watch. I was able to handle pretty much everything that walked through the door and it really helped me mature from just taking history and physical exam, to managing the patient from start to finish independently (in most cases). It forced me to think more like a resident and that made me learn A LOT. Not only that, but this was the first rotation where I felt the staff really put effort into giving the med students a great experience. I really felt like they cared about us rather than using us as work horses. They, meaning the residents AND attendings, really made me feel welcome and like they genuinely wanted to help me. At a lot of rotations, it somewhat feels like they look down on you, sort of like a fraternity/sorority and you're the new pledge (not that I would know since i wasn't in either lol, i just think thats what it would be like). Dayton isn't really the most appealing city, but I would go there for the EM program to learn from these awesome people. I feel like i fit in better there.

So all that being said, I'm in San Antonio now!! I've been here for 2 days. Today was my orientation day and all I can say is this is TOTALLY DIFFERENT from the Wright-Patt program/ base. This base, Lackland AFB, is where all all of the new enlistees get trained. Every enlisted person comes through Lackland AFB for what's called, Basic Military Training. It's essentially "boot camp" for the Air Force. So naturally, there's lots of young airmen around here learning the ways of the Air Force. Because this is a big "training" base, they do pretty much EVERYTHING by the book. The rules for pretty much EVERYTHING are highly enforced, almost to a fault. It's not a bad thing necessarily, it is just crazy how 2 bases can be so different from one another. I haven't felt so scrutinized as far as uniform wear, proper military customs and courtesies, since i was in ROTC. I had heard that it was different here, I guess this is what they meant.

So today was a long and pretty frustrating day. Orientation consisted of running around to various offices to complete all the in-processing paperwork. In true military fashion, nobody knew what the heck was going on and it was highly disorganized and made no real sense to me. (as much as this goes against every fiber of my being, i had to just accept it and not ask why). This was what made it very frustrating for me. Here I am running around all morning getting confusing documents signed, getting totally random immunizations and lab tests (polio, HIV, and tDap???). I, along with 30 other students are given "priority" over anybody else who needs vaccination or tests because we "need" these done today. This is what really got me...There was an active duty MSgt who sadly had to wait for about 3 hours to get his vaccines and documents signed for his Humanitarian trip to Haiti, which he is leaving for TOMORROW, because we all had "priority". Really Air Force??? Since when does my rotation take precedence over a mission to a third world country to provide medical aid??? This along with a few other frustrating events today really took me back to the part of the Air Force that I struggle with. There's often a HUGE disparity between doing what makes sense/most efficient and what the Air Force sees as best practices. Some of the time, it seems like the AF does the opposite of what makes sense. I have some theories for why this is, but that's not really the point. Today I was reminded of exactly why I struggled to get released from the Air Force to attend med school and it almost felt like I was meeting my old enemy, beaurocracy. Obviously, today wasn't nearly on the same scale, but it was a quick taste of what that was like, and i DO NOT miss it. So I don't mean to sound like I'm complaining about the Air Force, because I'm certainly not. Some days I struggle with balancing the positive and negative, especially when I have a frustrating day like today. It pains, ESPECIALLY when things make no logical sense, to just "do what I'm told" without asking the question of why. I know this is the way of the Air Force at times, but it's an ongoing struggle that I'm not sure i'll ever get over. I love the air force, it has only brought me great things, but some days, as with everything in life, I get a real good reminder of the things I don't love as much. Maybe that's why it's the military, it has inherent sacrifices. As much as I don't like doing it (because it doesn't really matter at this point), these really frustrating days make me wonder how different my life would be without the AF. I honestly have no idea.

Anyway, i've heard people say "some days you are the windshield, and some days you're the bug"...today I was the bug :( BUT, tomorrow is another day. And maybe being the bug sometimes makes the days when we're the windshield that much better! :)

I'm def going to be a windshield tomorrow!

Some Dayton Updates...

2010-07-25T15:46:00.000-05:00

So I'm nearing the end of my time in Dayton, it went by crazy fast. Probably because I was so busy and always trying to normalize my sleep schedule...such is the life of an ER doc I suppose. All the docs here say that's the worst part, the continuous changing of sleep cycle. It really hasn't been too bad though, I actually went running at 3am one night on base, it was pretty awesome.

I have my last shift on Tuesday and I'm doing our "final presentation" that we're required to do. We also have to take a "final exam" or something on the last day. This pretty much sucks because I've heard it's random and impossible to study for. Also, my test taking track record always haunts me. After that last shift I still have like 5 days in Dayton until my flight to San Antonio, so I'm hopefully going to climb and explore a bit more.

I had my interview last week and overall, I think it went great! (but who really knows, they could've thought i was the weirdest person ever lol) I consider myself personable but when it comes to the "official dog and pony show interview" i tend to get nervous. I just am not a fan of putting on a show for people and selling myself with all of this "i'm going to tell you what you want to hear BS". And there are A LOT of applicants that I've met, not just here, but everywhere, that seem to be great at this. Maybe it's a negative thing that I somewhat struggle with the specific formalities of the things you're "supposed" to say in an interview. But, that's just not me. Sure I can interview well, but the second I try to pretend to be somebody I'm not, it goes down hill and I lose my train of thought and end up sounding like a tard. So, as I was preparing for this interview, which by the way was the biggest interview that I'll have since it's my #1 choice, I tried to not over rehearse or have any "canned" answers. I had main points that I wanted to touch on, but I mainly tried to focus on staying calm, being myself.

My first interview was with the Chief resident. It was pretty laid back but certainly covered all the main questions, i.e Why ER, Why AF, What are you good at, what do you suck at, etc. It was cool, but to be totally honest, the interview seemed really formal for what I was expecting from a resident. The other students confirmed that he was sort of too "by the book". He was really nice and everything, I just felt like he was rushing through questions he "had" to ask and that made it seem somewhat impersonal.

The second interview was with the program director, and the session I was the MOST nervous for. So after all of the build up, this session turned out to be my favorite one so far. This doc (who was the same guy with the situs invrsus kid i wrote about in my previous post) is absolutely, without a doubt, one of, if not, my most favorite AF doc. We hadn't had anytime together on any shifts so I was worried he wouldn't know me that well. But as soon as we started talking it was crazy because it was so casual and informal. I honestly felt like I was talking to one of my best ROTC friends, and that made me feel really good. He didn't ask me any of the typical questions. He flat out told me he was really happy to see how much we had in common (he did ROTC also) and he wanted to hear about how I've gotten to this point. This interview was more like I was talking to a friend, it was really crazy. He wanted to hear about my ROTC life, my maintenance experiences, and how the heck I managed to get out of that to go to med school...apparently he understood how difficult that is. So i talked about that and how it started out as something I hated, but turned into one of the best experiences of my life, how it made me who I am today. I mentioned how I sort of feel like "fit in" better with my air force friends and what it means to me. Towards the end of the talk, he said some things that make me feel like the interview was a success. He told me that I'm a really unique applicant for a few reasons. The prior service thing, being in charge of more than 50 people, which in the med group, you only do when you're Lt. Col or above (aka i have more leadership experience already than him and most of the residents and practicing docs lol). But the thing that he said that made me really happy was that he told me I reminded him of himself and he could tell by my enthusiasm that I was being real. Going back to my whole thing of hating the formality of an interview, this was awesome to hear. Not only did I feel like I could be totally myself with him, he picked up on the fact that this conversation was different than the usual fake interview. That's an overall success for me, no matter what happens.

So i guess it's out of my hands now, I did my absolute best, and left it all on the field, so to speak. I know there are LOTS of people interviewing and competing against me, I just hope I'm different enough to stand out when the board meets. But if not, if I have to fight my way through again and do a general medicine year, that;s ok too. It's not like I haven't been in that position before, except that was worse lol. I'll be fine because even when it doesn't work out, it actually does, just in a different way. ;-)

Right where I belong...

2010-07-20T14:55:00.000-05:00

Last week's conference, although it was an incredibly stressful day, was one of my favorite days of this rotation. It was stressful because we just got the numbers from the AF for how many ER docs they needed and it sort of hit me that this whole match process is finally here. That plus seeing other students interview and hearing how competitive it is really freaked me out for a bit. The thing that brought me back down to my baseline level of insanity was a presentation by the program director. He was lecturing on thoracic emergencies and did a separate presentation about a case he has while deployed to Bagram Air base, Afghanistan. I'm going to try to tell the story the way it was presented...

The case was about a 7yr old Afghan boy he took care of immediately after an IED (improved explosive device, basically a makeshift bomb insurgent's plant all over town) went off in village market in the middle of the day. There was a large number of women and children hit and he happened to see this boy. This sort of thing happens unfortunately, pretty frequently. Kids are brought to Bagram all the time and taken care of. This boy, however, was not like any child routinely seen anywhere. On initial exam, before delving into his blast wounds, the doc noticed something strange about his fingers and toes. They looked something like this:

For non-medical people, it's called "clubbing" and the exact physiology of it isn't really known but it's hypothesized that it's caused by a process that allows for right to left shunting of blood in the heart and leading to the mixing of oxygenated and deoxygenated blood in the body. It has been seen in people with long standing COPD, lung cancer, TB, cystic fibrosis, etc, something basically affecting oxygen content in the blood. Anyway, so as the primary survey goes on they notice this clubbing, puncture wounds to his chest and abdomen, and some other minor cuts. So just from the clubbing alone, doc new something was not totally right. As things progress and they start the trauma series of xrays, labs, etc they quickly realize this child is incredibly unique. His chest x-ray looks something like this:

Notice anything wrong?? (I thought of scrubs at first and how they hang the xray backwards at the beginning of the show lol) But no technical error here...his "stuff" is on the wrong side! Heart and stomach, both on the right! This kid had what is called, Situs Inversus, basically where his organs are transposed to the opposite side of his body. He also had transposition of the great vessels of his heart, aka the main vessels of his heart were also reversed. Crazy right? How is this kid even alive?? It's crazy because transposition of the great vessels is a condition incompatible with life in 100 % of cases UNLESS, unless, unless, there is small hole in just the right spot in his heart. In other words, his heart is totally backwards and this small hole, a ventricular septal defect, is allowing this crazy rearrangement of blood vessels to adequately oxygenate his body. Holy crap right?? Mind you, this kid is 7yrs old!! Which means, for his entire life, from the day he was born, his little body has been working sooooo hard to compensate for this congenital heart abnormality. AMAZING.

So back to his resuscitation. After docs quickly figure out sort of what they're dealing with, they get some labs back. The only 2 real labs of importance to explaining this case are Oxygen saturation and Hematocrit. Oxygen saturation is around 81%, which is low, but not as low as expected for somebody who probably has a huge hole in their lung, normal is greater than 92. His hematocrit, just a measure of the actual red cells in a blood sample, was also 81%, normal is anywhere from 40-50%. So this kid's ox saturation and his hematocrit are the same!!! This basically means this kid's blood is incredibly thick, to the point where this level of Hct is never seen, like ever! It's another way that his body has coped with this heart disease that he has, that's one of the ways he gets more oxygen, is to make lots and lots of red blood cells to carry more oxygen. Again...amazing.

So now the docs realize that their previous knowledge of "normal" physiology has gone totally out the window. How can you even begin to try to treat/correct/maintain his physiology when you have no freaking idea what is his "normal" in the first place? All they really know is that he needs surgery to remove metal that is in his lung and abdomen making him bleed into his belly.

*Side note: My favorite part of this presentation was when the doc was telling how $hit was hitting the fan and he had to run back and forth between this kid and a few others. He described what I can only picture to be the extremes of emergency medicine, badass docs and nurses running around making things happen in mass chaos. (doesn't that sound incredible?) My next favorite part of the story is when the doc, after getting the kid somewhat stable, tries to get a pediatrician (since he is 7yrs old) to take over. The poor peds guy practically craps his pants at the thought and refuses! I'm sure he didn't refuse because he was a jerk, I just think he was too scared to take on the case. :-) Sorry to all my peds friends, but I had to throw this in there.

Anyway, to make a crazy awesome, but long story short, the doc ends up putting a chest tube in the kid and taking him to surgery to remove the shrapnel left in his chest and abdomen. He survived the surgery but sadly died from complications of pneumonia several days post-op :*(

It is really really sad that he didn't make it. My first thought was, poor guy, so unlucky, just caught in the wrong place. But after really thinking about it, turns out that he was actually incredibly lucky to even be in that market in the first place. He basically overcame all odds to even be breathing, let alone live for 7 years. He wasn't just lucky, he was a walking miracle. We'll never know how long he would've really lived had he not been hit with that IED, but it surely wasn't going to be very long. It's even more amazing that he survived surgery. There's so much that has to go right in his physiology to sustain him, his body has been perfecting this for years. Surgery is highly risky in "normal" people, let alone him. So all in all, the fact that he died in the end while really heartbreaking, it's just a testament to how big of a miracle his life was to begin with.

After/during this presentation I pretty much had chills. One of my dreams is to travel the world and practice medicine in places that doesn't have doctors really. To treat people, like this little kid, who have never seen a doctor in their lives. It's a huge reason i joined the Air Force. So although I sometimes have my doubts about how the AF will impact my life, hearing stories like this puts everything back in perspective for me. Stories like that are the exact reason why I'm here. Nothing pumps me up more than to know that I will be (hopefully!!) able to go around the world and have my own stories similar to this. Of course being a doctor alone is sweet, but being one of the few people who can handle crazy cases like this one, and help people that would otherwise NEVER see a doctor is incredibly exciting.

There's a lot to worry about right now in this stage of the game. Residency applications, board scores, what happens if I don't match, where will I live, what if I'm still single at age 50 (lol, jk), it's A LOT to think about. I do my best NOT to think about it too much and reassure myself that things will work out, they ALWAYS do. But that day, sitting there listening to the story about that miracle boy made me REALLY realize something. The feeling I got from it made me see that although i am unsure of LOTS of things, like where on earth I'll be next year, or what I'll be doing. One thing I DO know is that right now, pursuing this dream, (totally stressed and confused and scared) no matter what happens, I'm exactly where I belong and wouldn't have it any other way.

Just a few more months....

2010-07-18T01:34:00.000-05:00

So there's a lot I have to write about, but it's late, and i just got off a long shift. But I just wanted to comment on the 2 things about my shift tonight that stood out more than anything:

1. "are you a real medical doctor? As in, you went to medical school? Because you don't really look like someone who would become a doctor."

I don't take personal offense to really anything a rude patient or even more rude family member says to me. This isn't because I have no emotion and am an "ice queen" as most would say. But mainly, it's because 99% of the time, the people being rude jerks in the ED are just not smart, at all, but they somehow think they have this wealth of knowledge because they have a 4th cousin who is married to a guy who knows a doctor, or something retarded like that. Anyway, tonight I went into a patient room to see a kid with a rash. No big deal, he has a rash. My first thought was (as I'm seeing this 5yr old kid, with no apparent rash, jump up and down through the door screaming along to the cartoon on the tv)..."wow, this kid couldn't be farther from having a life emergency, dandy." This also give me the first clue that his mom probably is not the brightest crayon in the box. So I go in, start talking to the little guy and mom. Before I can really start asking questions, mom flat out asks me if I'm a real medical doctor and proceeds to clarify that she's asking if I went to actual medical school. It was funnier than insulting actually lol. I had to stop myself from laughing almost. "did she really just ask me if i'm a medical doctor that went to real medical school?"

I explained I was in fact not a doctor yet, but am almost finished with ACTUAL medical school (the kind where you learn medicine and stuff). She was shocked because apparently, "you don't look like you would become a doctor." WTF? I'm still not sure if that's a good or bad thing, i'm still sort of laughing at the whole encounter. But i assured her that despite my looks or whatever, I am qualified to be asking her questions about her son's non-existant medical emergency that she calls a rash. I basically told her some benadryl would clear up the miniscule red spot and "itching" her boy was having. 5 mins later, the attending comes in (only to appease her because I could tell she didn't believe me), and says the SAME EXACT WORDS, almost verbatim. I wish I could've had a camera to video her reaction that was SO appreciative and relieved and made it seem like the attending had just told her how to win a trillion dollars and I had told her nothing. SO...what did I learn from all of this and this crazy lady, other than the fact that apparently I don't look like a doctor and 95% of the people I see in the ED are very very unsmart. I learned that i CANNOT wait until somebody asks me that question and I can answer, YES DAMMIT I'M YOUR FREAKING DOCTOR! :-)

2. So tonight seemed to be "vaginal bleeding in pregnancy" night in the ED. We had about 5 women in a row come in for vag bleeding all less than 15 weeks or so. I got lucky enough to work all of them up and by the 3rd one, the doc was letting me pretty much solo the patients, meaning, I'd do everything, orders, exams, and they would just say a quick hello at the end, when OB/gyn came down. My 5th lady that came in though, she was the one that gave me an experience that I don't think I'll soon forget. She was bleeding pretty badly, hadn't felt the baby move in a couple days. When I told the attending about her he sort of grimaced and said in not so may words, he was pretty sure the baby was not viable anymore. So, with this in mind, I go in and do the pelvic to work her up just like everyone else. Mind you, this poor girl had been crying from the second she put the gown on, she had 2 previous miscarriages at around this same time. I set up the ultrasound, trying to console her without giving her false hope, but also without being unrealistic, she had lost a ton of blood. So as I'm getting the probe on her belly, doc walks in and stands there waiting to help me give her the bad news that her baby's heart isn't beating. So I look around for a few seconds and seriously, it was the craziest, one of the most emotional moments I've had in med school for some reason. Not sure if it was because you could feel the fear in the room from this girl at the thought she lost another baby. Maybe it was because it was my first time or so really being the one to find or not find a heartbeat. So after looking for about 2 seconds, I found it...it was beating strong and baby was moving. Right at that moment lots of things happened...i'm pretty sure my own heart stopped for a quick second, the patient screamed/sobbed louder than crap, and even the attending let out a "wow." It was amazing and i was so happy that I let the probe slip and I lost the heart lol...but I found it again fast! So everyone was happy, not totally out of danger, but the baby was alive, unlike we all expected. I guess I never really grasped/felt how surreal it is to see your baby's heart beat on a screen. I've seen tons of them, but tonight it really hit me. I've never seen my own baby's heart beat (obviously!), but if this is even an indication of what that is like, all I can say is life is really a miracle. So yea, I'm pretty confident that I won't forget those couple of seconds for a long time. I should also not forget to not drop the probe during such crucial moments lol.

More updates to follow :)

Day off :-)

2010-07-13T22:25:00.000-05:00

So today, other than a 2 hr lecture, was a day off! I have tomorrow off as well so I used today to really work on my personal statement for the residency application. I really struggle with writing formally so it's taking me FOREVER. I want to include things about my previous military time and past struggles I've had to get where I am. It's just really hard to articulate it the way I want it to come out. ALso, it's difficult for me to write about myself and somewhat "sell" myself to program directors. I'm a MUCH better speaker/interviewer than writer :-/ Nonetheless, it's coming along. I have my interview on July 23rd so I hope to be done with the personal statement by the beginning of next week. As far as the interview, i'm nervous about it. I know all I can do is be myself, be honest, and hope for the best. I'm just hoping I don't say something stupid lol, i have been known to do that from time to time.

Overall though, being here, on a base again, surrounded by people in the same "boat" as me has really calmed a lot of worries I was having in the months before I came. Being disconnected from AF people and things, while still having to make plans with the AF in mind was stressing me out. It's sometimes difficult for my peers, and even my closest family and friends, to really grasp the concept of why I would even want to be in the military. They certainly support me and are behind me no matter what I do, good or bad, but that's different than somebody who just understands and gets it. I love my supporters and don't know what I would do without them. But sometimes, it's refreshing and super reassuring to be around people who I don't have to explain anything to...they just know and feel/understand where my driving force comes from, nor do they see it as a nuisance. I think I was just getting the feeling that I was alone the past couple of months. Alone in the sense that I was constantly defending and sometimes even doubting all of this Air Force thing. Now that I'm here though, I remember exactly why I make and have made certain choices for myself that could potentially make my life very difficult and non-traditional. I guess you could say I like I belong to a "team" (wow cheesy!!!) again. So I know it's silly to feel like I'm alone in this, because I know I'm not. Maybe I just needed to see other people doing this, and not only doing it, but being incredibly happy doing it. So being here has been great on more than one level, I needed it.

A month and a half until I'm back in AZ! With my little abbey girl and in my own bed! I still have a bit to go, but I am getting excited :-)

It has been a good day off, and this song always makes me relax :-)

Long day...

2010-07-12T20:39:00.000-05:00

So I'm on my second week of my ED rotation. So far I have had a great time. Today, however, was by far my favorite day of all! We had a procedure lab where we were assigned to a live pig (about 100lbs) and got to do a bunch of procedures on them. We practiced getting intra-osseous access (basically sticking a large bore needle into a long bone when you can't get a peripheral IV), chest tubes, cricothyrotomy (hole in neck for airway), thoracotomy (cracking open a chest), diagnostic peritoneal lavage ( flushing fluid in the abdomen looking for blood), and cardiac massage!! A couple of attendings and the program director were in my group so I either made an ass of myself of did a good job to impress them, who knows lol. But it was really awesome to be exposed to the setting where we can actually learn those types of procedures on live animals. I love that they put that much effort into teaching us on this rotation, it really makes up for the slow ED :-)

Everyday I'm here, and the more I talk to the residents, I love this program more. It's not as in your face military as San Antonio is, you get close to 5 civilian hospitals in your rotation, rather than just 1 big hospital, but most of all, the people are amazing. The people/personalities are what matter the most to me and if I can see myself happy working with these people. Granted, it IS the AF and people move around sooo much, but I feel like I can really fit in here. Also, I do want civilian hospital experience, and you get that for your entire 3 years here. I do love the AF, but i think I will really like the civ/military mix of residency life they have here. Sometimes they are the bane of my existence, but the homeless drunk does have his/her role in teaching students on how to be a good ED doc lol.

In other news, i've been running a good amount here. The base is pretty, pics coming soon! There's a sweet rock gym not far from here and I think i'm going to head there in the next couple of days. I've been sooo busy lately and they sneak lectures/labs in on my days off so I haven't had time to explore it yet. This week though!!

Ok more updates later!

Something I wish I didn't learn today...

2010-07-10T19:14:00.000-05:00

It is still possible for people to fart during a rectal exam.

Lesson learned...unfortunately.

My first 2 shifts!

2010-07-08T01:17:00.000-05:00

So I've been in Ohio at Wright-Pat AFB for 3 days now and I've had 2 ED shifts. Overall, they're been pretty good. The base hospital where I'm rotating is not a big place like I thought it was. There's no real trauma or real emergencies for that matter. The people that come to the base medical center are either retired military or active or they're dependents. Also, there are very few actual emergencies that come to the ER here. Most of the complaints are things that can be handled by a family med doc as an outpatient. That's just how this small hospital is set up :-/

That being said, the residency program here is actually quite awesome. As an intern/resident you actually don't spend anytime on this base hospital and you're out in the civ world at the big trauma hospitals around the Dayton area, so that's cool.

I have met some crazy awesome docs though. Although the actual flow of real emergencies is relatively low, I'm learning LOTS and getting to basically make the decisions for my patients, write the orders, and much more! So it's been great so far.

The other thing I'm learning is how different the medical side of the Air Force is from the operational side. I would NEVER think of calling a Col by his first name, much less a nick name, and here it's expected...crazy. I guess because of the team dynamics of the ED with nurses, techs, and docs, the relationship is closer and more laid back. I like that it's laid back and informal, I never really liked the whole "power hungry salute me because i'm higher ranking than you" thing that goes on. Some people might argue that its a bad thing for the enlisted and officers to be on a first name basis when the rest of the AF is not, but trust me, everyone still knows who is the doctor and who is really in charge...regardless of the rank. So it all works out.

Things I have learned so far:
- Don't assume that military members/dependents are less crazy than the average population...the crazy is still there, it just hides better in the military.
- I despise decisions based on pure politics, well this i already knew
- I hate being called ma'am
- How to remove a foreign body from an eye with a TB needle
- still not a fan of the pelvic exam despite my female-ness

It's 2am, and i'm falling asleep so better and more well put togther posts are coming soon!

Leaving on a Jet Plane...

2010-07-04T02:55:00.000-05:00

So my week of post-boards relaxation has finally come to an end. I've spent the week mostly relaxing, packing slowly, watching soccer, and enjoying my free time. It was a great week, but I'm definitely ready to get back in the hospital and get back to work. I'm leaving on Monday morning at 6am for my 2 month adventure back in to the active duty Air Force. I'll be going to Wright-Patt AFB in Dayton, OH for 4 weeks and then Wilford Hall Med Center in San Antonio, TX for another month. The only difference this time is that I'll be working in the ED, not on the flight line :) . I have sort of mixed emotions about how these next couple of months are going to go. I'm extremely excited to finally rotate at places I may actually end up and get a glimpse into what could quite possibly be my life for the next 3 years. With excitement comes the nervousness of "holy crap, I've been off active duty for 3 years, I'm gonna look like an idiot!" On top of this, there's the anxiety that I MUST impress these programs so they actually pick me from the hundreds of applicants. One good thing though, is that I feel ready to finally see what it's like to combine my Air Force life with my medical life. I've done them separately and I hope I realize and get that feeling that the combination of the two is exactly what I'm supposed to be doing. So, i'm excited/nervous/anxious/ready for the next 2 months!

Things I plan to do/keep up with while I'm gone:
- RUNNING!!
- SWIMMING!!!
- RIDING (i plan to participate in the SOMA 70.3 triathlon again this year in October so I gotta get my butt in gear!)
- CLIMBING
- TAKING PICTURES (of everything of course!)
- oh yea and reading and learning lots of Emergency medicine things :)

So that's what I'm up to for the next couple of months. It comes at a great time too...it's crazy HOT right now so it'll be nice to get out of AZ. Not to mention I've been wanting to get out of town lately. I love AZ but something has been making me antsy, like I need a slight change of perspective as of late. Not really sure why that is really. But hopefully I'll get a much needed change of perspective on the many things I purposely place on my already full plate. Maybe I'll just want to add more? :)

I will miss my abbey though :( She'll be hanging out with Xiomi and they're going to keep each other from getting lonely, abbey was put on this earth for that, I'm convinced of that.

Well stay tuned for funny ER stories, angry rants of frustration, crazy ER times, and funny Sasha stories...we all know I can get myself into the craziest situations.

Losing my mind...(even more than i have already)

2010-06-26T12:09:00.000-05:00

It's Saturday, my Step 2 board exam, my last big exam in medical school, is on Monday. I have been sticking, pretty well I might add, to a schedule I set for myself 2 months ago. I don't do anything training or studying on a regimented schedule so I'm proud of myself for doing that this time. Thus, I am losing my mind now that it is 2 days before the big test!! I am burned out from studying, have the attention span of a gnat (hence my blog posting right now) and would just like to get the dang thing over with! I'm so over studying that I even stared at my swim goggles for a good 6 minutes straight today thinking of reasons why one side always lets water in but the other doesn't..yea, wow.

Phillip= Sasha

Wish me luck on Monday! :)

Daydreamer...

2010-06-09T21:10:00.000-05:00

So time has been flying this month! Last month flew by probably because i didn't ever sleep, was surrounded by the crankiest people ever, and the month was a blurr, like one looong day. My cousin moved in a couple of weeks ago and we had a week to just hang out and explore arizona. She likes AZ a lot and is adjusting to the heat pretty well. I've taken her rock climbing (which she loves), to spin class, yoga, and hiking. So far i think she's enjoying it and still getting somewhat settled. I've spent my mornings on Radiology rotation that entails me reading films/CT's/MRI's/etc for about 2-3 hours and then using the rest of my free day to study. Having the day off would normally be really tempting to go hiking or spend a couple hours climbing or running. Fortunately for my studying regimen and unfortunately for my sanity, it's so dang HOT until about 10pm that the thought of even running a mile outdoors makes me have a heat stroke. I can take the heat pretty well usually, but this heat doesn't even make running enjoyable. I swam the other day and after a few laps I felt like i was swimming in a hot tub...gross. So due to this sub-optimal heat I've resorted to sticking with climbing, swimming, yoga, and spin class this month!

Anyway, I'm excited for boards to be over at the end of the month. July and Aug are going to be big months for me since I'm going to be in Ohio and Texas. I'm trying not to stress too much about these audition rotations, do my best, be myself, and just hope things go smoothly. I know one thing, I neeeeeed to find either a pool, a sweet running route, or a rock gym to make it through the month. So the stress from paperwork, board exams, setting up rotations, filling out residency applications coupled with my "free" time spent studying usually in startbucks or some other coffee shop, has made me somewhat of a daydreamer. It usually happens when I'm distracted by people watching or taking a short break from reading (LIKE RIGHT NOW) that I start wondering what it would feel like if I didn't have med school, AF, studying, all of these things on my plate. It only lasts a few minutes, but I do try to picture myself and how life would be if I never had/wanted these things. I see a lot of my friends doing things now that I usually say I'll do "one day", I've been saying that for as long as I can remember. Not that I'm not doing anything, but sometimes I do with I had the freedom (AND MONEY!) to pick up and go somewhere for the weekend, or longer, and not feel guilty about how i'm not studying or not reading or how I'll have to watch for emails from med school things. I'm not complaining really. I chose this and I wouldn't change anything about my life and how it has played out so far. I have met some amazing people along this path that I don't know what I would do without. I just know all of these things, the studying/books/AF/working out/my shenanigans/crazy running around all the time trying to be in 4 places at once...it's me. And really, it's tough to picture myself doing anything else. But it would be nice to actually try out the gypsy life for a short period of time. To take breaks from my daydreaming and adventurous life to study,not the other way around, would be awesome. I'm not sure that I would even know where to start, but I'm sure I could figure it out eventually. But for now, daydreaming on my study breaks will have to be the extent of my gypsyness. :-)

Song that's stuck in my head: Adele-Daydreamer

Ms. B...

2010-05-19T18:45:00.000-05:00

So this surgery month, that is almost over, has been quite demanding of my time and patience. I don't necessarily get pimped a lot, but I am held responsible for almost everything...even when the OR lights burn out. That's clearly my fault. Not to mention my surgeon isn't the biggest "people person" with his attitude that no patient encounter should take more than 5 minutes and time=money. He's a very great surgeon, but his people skills are kind of iffy. So being around him and scrub tech's that hate their life and have a negative attitude towards everyone and everything has sort of sucked me in a little bit. I found myself today staring at the clock as a patient was talking realizing exactly when the 5 min mark was up, getting bitterly angry at people for continuing to smoke and not control their diabetes which forces them to us for toe/foot amputations, feeling disgusted with morbidly obese people for smelling like they crapped themselves, etc. I guess I was just caught up in being bitter with my patients in general. (maybe it has to do with sleep deprivation?) Anyway, I was in the ICU today seeing a consult, homeless guy, found down in a park, bleeding from nose, mouth, rectum...needed surgery for perforated gastric ulcer and esophageal varices from years and years of drinking. In the midst of being mad at him for drinking himself into the ICU, i walked by an old pt of mine who has been in ICU for 15 days now. We took some of her colon out because it had twisted on itself and was necrotic and she later got pneumonia and had to be intubated. She's been intubated for over a week now and I've stopped seeing her daily because there's nothing for us to do anymore. She's slowly bouncing back and forth from getting better to doing worse with her pneumonia. But today, she was awake. I saw her looking out of her room, tube in mouth, holding this super soft pink little stuffed dog she's had since the first day i met her. Before she was intubated, she was always the sweetest lady and called me "love", well, i guess she still is sweet, she just can't talk. I hadn't seen her in a few days so I walked in to her room just to say hi and look at her tummy and i was sort of shocked by her reaction to me. I grabbed her hand first and then she just latched on like there was no tomorrow. It really caught me off guard because she was wide awake and i guess just wanted to hold my hand. After a few seconds she grabbed it and pretended to kiss my hand, around the tube in her throat of course. It just really moved me and made me sad because I hadn't been seeing her daily and it seemed like she really needed somebody to just be there and for once, not look at al her tubes, holes, drains, etc. I stayed as long as I could but before I knew it I could hear my name being called from the hallway to hurry up and get moving, actually the surgeon calls me "girly", not even by my name lol. But Ms. B sort of made my heart sink and put things in perspective for me.

I was getting caught up in being angry and bitter, just like a lot of people in the medical field. You always run across these doctors that are just genuinely happy people and have a great attitude, but more often than not, they're bitter and hate people...I don't get it? Didn't they have to actually WANT to help people at one point? What happens in the course of residency and then years later that makes the love and compassion for people completely disappear? I can imagine that it's the "bad eggs", so to speak. The ones you see repeatedly for problems they cause themselves. The people that despite surgery after surgery, infection after infection, don't quit smoking, don't lose weight, don't take care of themselves. It's the ones that feel entitled and demand you fix what they have been doing to themselves for their entire lives in a few days. The ones that say "you're the doctor, fix it." I'm not naive and I'm not saying that I'm never going to be jaded and bitter, of course I am, it's already happening! But I can at least acknowledge it and make the decision to not let it overtake me and lose sight of the reasons I started on this crazy journey to become a doctor, reasons like Ms. B. Why do we allow ourselves to be bitter all the time and let the "bad eggs" leave a lasting mark. Why isn't it people like Ms. B, the great, sweet lady who got unlucky and is fighting to live, that leaves the biggest impression on us?? I know there are more bad eggs than good eggs, so it seems, maybe because the good eggs are healthy and don't need hospitals?? But the good ones definitely outweigh the ones that make me bitter. And for every 20 bad ones, 1 good one is enough for me to realize the choice I want to make. The choice to take more than 5 minutes, let people talk a little longer, try to see their side and despite my surgeon, call patients by their name, and not, "cancer girl" or "stump man". (yes he actually calls them that, not to their face, but he doesn't know names.) I just can see that if you let yourself fall into the bitterness black hole, then no matter which kind of people you see, eventually they will all be "bad eggs" in your eyes. And who wants to live that way? I guess the bottom line is there are MANY, too many, bad eggs out there. Care for them, be compassionate, and even get angry at them, it's ok. But don't let them drown out the good ones, keep your eyes and heart open for them... they're the ones we started this whole battle for in the first place!

Ok now I'm off to study and sleep before 9pm. I have 1 case tomorrow and then get the rest of the day off!! woot! :)

The beat goes on...

2010-05-16T02:48:00.000-05:00

Semi quick update on rotation:

I've been really busy the past few weeks! I'm on a surgery rotation that actually isn't as physically demanding as my last surgery rotation, it's more of a mental game. My doc is great, tough on students and makes us work hard, but still great. The 3am wake ups followed by mostly 12-15hr days, 5 days a week is kind of tiring. But the worst part of this rotation has been dealing with the personalities in the OR. My day consists of quietly rounding on my own from 4am-6am on about 8-11 patients, making sure the charts are all in order and everyone has been checked on before doc get's there at 6am...no big deal, despite the fact that I'm not entirely awake and looking closely at colostomies and freshly amputated stumps isn't the greatest smell that early in the morning. (not that its ever a great smell!) My real work starts around 7am when the first case begins and I assist on surgeries while dodging bullets from the scrub tech (hands instruments to doc) and first assist (a nurse that helps the surgeon operate). It seems like no matter what I do, or how great I do something, they always have a negative comment or something to scold me for. I'm not a sensitive person in these situations and i can take a scolding without letting it get to me pretty dang well, but when people who have 1/3 the education I have start yelling at me...I have a problem. Not only yelling at me, but the scrub tech actually stabbed me with a suture needle when she was yelling at me and yanked it out of my hand! I'll just say that we had some SERIOUS words right then and the day after, and since then, she's been fine. :) I just don't tolerate blatant disrespect and people taking their problems and bad attitudes out on me. ESPECIALLY from a menopausal scrub tech...sorry you're having hot flashes lady, deal with it!!! But all in all, I'm enjoying the rotation. My sewing skills are improving and i'm learning lots of different techniques.

What I really wanted to write about tonight was how things change. As in a change of heart, change of perspective, and i guess just how things can just change in the blink of an eye. I'm pretty sure that everything changes in some way or another. People always say "Time change everything/everyone", and for the most part, I think that's true. But I just get amazed at how certain things, beliefs, ideas, goals, etc can change seemingly overnight, taking no time at all. Maybe it's just that the gradual changes don't affect us as drastically. An example, our last case on Friday was an operation on a man to remove part of his colon that was full of cancer. He had abdominal pain on Thursday, came to the hospital that night, and by friday at noon, he was told he had stage 4 colon cancer, needed part of his colon removed and was told he probably wouldn't live another year. During the surgery the doc had me literally feel the inside of his abdominal wall and his intestines and all I could feel were little bumps...all tumor seeds. This 56 yr old man went from working full time, living a happy life with wife and 4 kids to knowing his entire abdominal wall was being overtaken by cancer and he would die soon. His life changed in the time it took us to say the words.

Another example, the end of a relationship. Generally speaking, when you're genuinely happy with someone, time seems to go by fast. Everything looks a little different and you sort of feel like your heart is smiling all the time. But it's crazy to me how all of that can go away overnight and you're right back to where you left off. Something sets the ball rolling in the wrong direction (sometimes without you even knowing) and without warning, here you are, back in a familiar place, feeling just like you never left. I guess all you can do is pick up where you left off and keep going.

I guess my point is that you just never know. I'm constantly amazed at how drastically and quickly our lives can change. One minute you're blissfully happy and your life/health has a great outlook, and before you realize it, it's all different, maybe for better, maybe for worse. Either way, nothing really seems to ever stay the same and it's just a matter of how and how soon things are going to change. Makes me want to just enjoy the right now, all the time, because tomorrow it can all be different, and the only thing you can do is react.

One of my favorite songs my one of my top 5 bands...
The Temper Trap- Soldier On

An exciting week of being a nurse AND a PA! (warning- gory picture:)

2010-04-24T17:23:00.000-05:00

So far my month in the ED has been pretty dang awesome. I've learned so much about medicine but probably more about people that come into the ER. I really really really do my best not to judge people but in the ED, you almost have to. It's crazy how great people can act to try to get pain meds from you, I've been fooled so many times already. They use the typical

"doc, I know you can help me, not many people have been able to. THere has to be something going on with me, this pain is unbearable (all while in tears) and I wouldn't be here if i wasn't at my wits end."

So naive newbie over here buys into it and really starts thinking of all the terrible things that could have bee n missed on a CT or the multitude of other studies the pt has had, all of which are completely normal. I distress myself thinking of all the things on a differential and present it to my attending really concerned. He takes one look in the room, without even really entering the room, and goes, "ok, got it, she's going home." His explanation was that she has "the look." Apparently, and i think I am starting to catch on, whether its good or bad, the look is just something you can just pick up after years working in an ED. There really isn't a way to describe it, its has no real specific features, but you know it when you see it. Is it just a biased/prejudiced opinion against the way some people look that come into the ED? Maybe, to some extent. But when "the look" proves to have a specificity of about 98% for diagnosing somebody as a "frequent flyer, drug addict that makes up stories for pain meds", I'd say there's some validity to that, not just biased and jaded opinion.

Here are some more highlights from this past week:

-On the way to work, not even in the ED yet, was driving and witnessed a teen vs. car accident right in front of me! It was pretty scary seeing the kid fly in the air and land on the street not even 20 ft from my car. For a split second I thought "holy crap, this kid is dead, I really hope there's a doctor in the area..."
And then i had the "oh crap, this is all me...the doctor in the area...ahhhhh that's me!!!" So before I could finish that thought and even begin to freak out about how I wasn't really sure what I was doing, my car was parked in the middle of the street and i was running over, in full scrubs as i was on my way to the ED, to see what was left of this poor kid who, by the way, was hit straight on by an extremely old driver going no less than 40mph! The kid, Antonio, was 16yrs about, was laying on his back just moaning in pain, left arm road rashed to hell, totally mangled, lacs all over his face. It was crazy because for the first time ever, I was telling people what to do, what not to do, and to calm down. It was funny, if you're a med student you'll appreciate this, I almost spouted off the "sir sir are you ok? you call 911, you go get a crash cart!" line from BLS/ACLS lol. But anyway, he was lucid enough to know what happened and to thankfully tell me his mom's phone number. It was almost 8 minutes before the paramedics came and all i really did was hold his head still and straight and have someone else hold his legs. After a few minutes he lost consciousness and most likely went into shock, just in time for the paramedics! (whew!) So I was able to talk to the medics and give them pretty much the story and most of what they needed. As I'm standing there with Antonio's blood on me, about to turn around and head back to the car to head to work, one of the medics walk over, shakes my hand and says..."thank you, he's lucky such a great nurse was around to help." Awesome lol.

- Going with the same "all females in scrubs are everything BUT doctors" theme, I was called "PA" by an asshole doc for my ENTIRE shift yesterday. It's me third week in the ED, he's seen me a million times with other docs. And he calls me, not even by my name, just "PA." He says things like "hey Dr. B, i got this great case for PA if she's interested." Most of me wanted to just correct him and tell him to at least learn my f'ing name. I don't mind as much if you think I'm a PA or a nurse, but at least have the respect to learn somebody's name for God's sake!

- Saw a lady with blood glucose of 1617, this is not readable on a finger stick. She came in in DKA (diabetic ketoacidosis) with a pH of 6.7. The pH that is compatible with life is no less than 7.0. We intubated her, pumped her with fluids and insulin as fast as we could, and just sort of watched her deteriorate. Her husband was out of town an last spoke to her at 0730 and found her at 6:00pm...which means she was probably in DKA most of the day. Her husband didn't seem too concerned in the ED, she'd been in DKA before, just not this bad. He said her insulin pump hadn't been working right lately. His only comment was "so is she saying overnight?" It was really sad to stand next to the doc who flat out told him, "well actually, her chances of living until tomorrow are slim."

- Got to reduce this sweet complete wrist disarticulation:

The story was this mexican lady who, naturally, was skateboarding at 2am while drunk fell and landed on her wrist. Her hand was literally dangling by the skin and that bone popping out is her ulna. The pre-reduction x-ray showed that both radius and ulna weren't even close to her carpal bones, pretty gnarly. Needles to say, the reduction was cool. I yanked on the hand while helping the doc push the bones back into the right spot. I was super lucky that night, thank you lady for being drunk and contributing to my learning!

- Witnessed a carotid massage ACTUALLY convert somebody back to normal sinus rhythm...that actually worked! I thought it was just in books. It converted right back to a-fib in 5 minutes and we had to cardiovert her, it worked for a bit! Crazy!

- For the first time I appreciated the honesty of a drug addict. Lady came in for being "zonked out" in a grocery store, nobody knew what was wrong with her, she walked there, sat down, and was out of it. After medics and nurses asking her if she had pain anywhere, the whole sleu of "protocol" questions, I was annoyed at her babbling and fighting with everyone and spitting on me, I just asked "what's wrong with you???" She politely responded in her slurred speech "nothing, just took a handful of methadone and xanax." My response, "ok great, bye!"

That's it for now. I'm in the Peds ED next week so I'm excited to be with the little ones that just make me happy. Something about a Madagascar decorated portable x-ray that just makes me smile :-)

"Suck It Up America"- This is what's wrong with healthcare-worth the read!

2010-04-16T21:46:00.000-05:00

So this is not my writing, but I COMPLETELY agree with it!

Sunday Forum: Suck it up, America

We have become a nation of whining hypochondriacs, and the only way to fix a broken health-care system is for all of us to get a grip, says DR. THOMAS A. DOYLE
Sunday, October 11, 2009
Pittsburgh Post-Gazette

Emergency departments are distilleries that boil complex blends of trauma, stress and emotion down to the essence of immediacy: What needs to be done, right now, to fix the problem. Working the past 20 years in such environments has shown me with great clarity what is wrong (and right) with our nation’s medical system.

It’s obvious to me that despite all the furor and rancor, what is being debated in Washington currently is not health-care reform. It’s only health-care insurance reform. It addresses the undeniably important issues of who is going to pay and how, but completely misses the point of why.
Health care costs too much in our country because we deliver too much health care. We deliver too much because we demand too much. And we demand it for all the wrong reasons. We’re turning into a nation of anxious wimps.

I still love my job; very few things are as emotionally rewarding as relieving true pain and suffering, sharing compassionate care and actually saving lives. Illness and injury will always require the best efforts our medical system can provide. But emergency departments nationwide are being overwhelmed by the non-emergent, and doctors in general are asked to treat what doesn’t need treatment.
In a single night I had patients come in to our emergency department, most brought by ambulance, for the following complaints: I smoked marijuana and got dizzy; I got stung by a bee and it hurts; I got drunk and have a hangover; I sat out in the sun and got sunburn; I ate Mexican food and threw up; I picked my nose and it bled, but now it stopped; I just had sex and want to know if I’m pregnant.
Since all my colleagues and I have worked our shifts while suffering from worse symptoms than these (well, not the marijuana, I hope), we have understandably lost some of our natural empathy for such patients. When working with a cold, flu or headache, I often feel I am like one of those cute little animal signs in amusement parks that say “you must be taller than me to ride this ride” only mine should read “you must be sicker than me to come to our emergency department.” You’d be surprised how many patients wouldn’t qualify.

At a time when we have an unprecedented obsession with health (Dr. Oz, “The Doctors,” Oprah and a host of daytime talk shows make the smallest issues seem like apocalyptic pandemics) we have substandard national wellness. This is largely because the media focuses on the exotic and the sensational and ignores the mundane.

Our society has warped our perception of true risk. We are taught to fear vaccinations, mold, shark attacks, airplanes and breast implants when we really should worry about smoking, drug abuse, obesity, cars and basic hygiene. If you go by pharmaceutical advertisement budgets, our most critical health needs are to have sex and fall asleep.

Somehow we have developed an expectation that our health should always be perfect, and if it isn’t, there should be a pill to fix it. With every ache and sniffle we run to the doctor or purchase useless quackery such as the dietary supplement Airborne or homeopathic cures (to the tune of tens of billions of dollars a year). We demand unnecessary diagnostic testing, narcotics for bruises and sprains, antibiotics for our viruses (which do absolutely no good). And due to time constraints on physicians, fear of lawsuits and the pressure to keep patients satisfied, we usually get them.
Yet the great secret of medicine is that almost everything we see will get better (or worse) no matter how we treat it. Usually better.

The human body is exquisitely talented at healing. If bodies didn’t heal by themselves, we’d be up the creek. Even in an intensive care unit, with our most advanced techniques applied, all we’re really doing is optimizing the conditions under which natural healing can occur. We give oxygen and fluids in the right proportions, raise or lower the blood pressure as needed and allow the natural healing mechanisms time to do their work. It’s as if you could put your car in the service garage, make sure you give it plenty of gas, oil and brake fluid and that transmission should fix itself in no time.

The bottom line is that most conditions are self-limited. This doesn’t mesh well with our immediate-gratification, instant-action society. But usually that bronchitis or back ache or poison ivy or stomach flu just needs time to get better. Take two aspirin and call me in the morning wasn’t your doctor being lazy in the middle of the night; it was sound medical practice. As a wise pediatrician colleague of mine once told me, “Our best medicines are Tincture of Time and Elixir of Neglect.” Taking drugs for things that go away on their own is rarely helpful and often harmful.

We’ve become a nation of hypochondriacs. Every sneeze is swine flu, every headache a tumor. And at great expense, we deliver fantastically prompt, thorough and largely unnecessary care.
There is tremendous financial pressure on physicians to keep patients happy. But unlike business, in medicine the customer isn’t always right. Sometimes a doctor needs to show tough love and deny patients the quick fix.

A good physician needs to have the guts to stand up to people and tell them that their baby gets ear infections because they smoke cigarettes. That it’s time to admit they are alcoholics. That they need to suck it up and deal with discomfort because narcotics will just make everything worse. That what’s really wrong with them is that they are just too damned fat. Unfortunately, this type of advice rarely leads to high patient satisfaction scores.

Modern medicine is a blessing which improves all our lives. But until we start educating the general populace about what really affects health and what a doctor is capable (and more importantly, incapable) of fixing, we will continue to waste a large portion of our health-care dollar on treatments which just don’t make any difference.

Anita Dufalla/Post-Gazette
Dr. Thomas A. Doyle is a specialist in emergency medicine who practices in Sewickley (tomdoy@aol.com). This is an excerpt from a book he is writing called “Suck It Up, America: The Tough Choices Needed for Real Health-Care Reform.”

Read more: http://www.post-gazette.com/pg/09284/1004304-109.stm#ixzz0TgtnEINR

Tri and some other funny ED quotes...

2010-04-16T15:17:00.000-05:00

So first a disclaimer about my excessively large blog picture- I swear I'm not that narcissistic to put up a huge pic of myself, I'm just trying to figure out how to make a collage of pics and use that as my blog picture and i can't figure it out, while not making it so freaking huge...work in progress :)

Reflections about my Triathlon-
Overall it went really well. Having my family there to support me was the best part though. All my races in the past have been with a couple of friends in the crowd, and while I love them, it was something else to have a lot of family there. They've never seen me race in anything and other than my dad, I'm not sure they even understood how big of a part of my life this is! So, I was really excited to see them there supporting me and it really reminded me that we really are nothing without family.

The swim in the ocean, although it was short, was a new experience for me. After being punched in the chest while warming up by a guy who was swimming in the wrong direction 30 mins before start time, I realized this swim would be the toughest part! I will say that i certainly didn't feel as cramped and like I was trying to swim over people as I do in a lake. The waves and chop were what made me nervous. I was lucky that I breathe on my Right side because I could sight all along the shore, that was nice. At one point I got really scared when I looked up to see the buoys and i saw nothing but open water...ahh! The first thing I could think of was omg i've been swimming deeper and deeper this whole time and i'm going to swim so far out right into a shark's mouth! But then I looked again and saw them not too far away in front, i just happened to be in a down slope of a wave lol. Other obstacles were the hundreds of jellyfish everywhere just waiting to sting me (they failed), drinking the saltwater, and actually being able to see the bottom of the ocean floor. Seeing the floor was different than swimming in a deep black lake because it added both a sense of comfort and fear to my thoughts. I could see that there were no huge creatures swimming under me as opposed to a lake where I'm blissfully ignorant to the creatures in the water...but then again, I was scared that I would actually SEE the shark that is about to bite my leg off! Maybe I should be thinking more about the swim time/technique than my imminent death by shark/jellyfish attack eh? But maybe it made the time pass faster because before I knew it I was at the last buoy and out of the water in 19 mins :) I was predicting about 15 mins, but I'll take it for my first open water swim!

The Bike and run were smooth, but slow sailing. I used my dad's bike, which was great! It was incredibly windy and going up some of the intercostal ramps was gorgeously brutal most of the time! I tried not to wear myself out and enjoy the weather and scenery while not being too much of a turtle on the bike. My time was about average mainly because I hadn't been riding much in the months leading up to it, oh well, I had a fun ride. Running is always my easiest leg of the race, luckily it's at the end. I use it as a time to think about the first 2 parts of the race and either yell at myself for sucking at swim and bike and force myself to make it up at the end, or just cruising along taking everything in. In this case I was just cruising along people watching mostly lol. It was a short distance and it was HOT! I ended up passing several people I saw fly by me on their bikes, this always makes me feel good :)
I saw my family towards the end and they were there waiting for me as I finished and I'll never forget my little cousin's comment "where have you been?!" lol...love it!

Some experiences in the ED this week and reasons I LOVE it:

- Had a lady tell me that she talked to God and he wanted me to know that he was always with me and my family no matter what happened. Made me worried at first because when old people (she was 90 and surprisingly not demented) start talking to God it usually means they're going to die. Later made me sort of emotional because I believed her. Crazy things happen in the ED, I just thanked her for the message and told her I'd never forget it.

- Saw a lady actively tweaking on meth. I never knew what "tweaking" meant but now I'll never forget it. She was very coherent and alert (which was surprising) but she looked like she was crawling out of her skin. Her head was jerking all over the place, her feet were doing these weird movements, and her hands went back and forth from fists to all these weird movements. It was crazy but mostly incredibly sad to see. I flat out asked her why she did meth and she replied that she just got out of jail and had been on meth for 6 days straight, she was sad because she couldn't see her 12 yr old son. She was actually brought in by a city bus driver, yes the driver pulled his bus up to the ER drive through/drop off, and brought her in because he was worried. (I guess there still are some good people in this world...or he just wanted her off his bus lol) Despite my usual cynicism with the angry drug addicts, I actually felt sad for this lady as she cried through her cracked out state talking about her son. She wasn't my patient, I just went in to see what "tweaking" actually meant and we ended up talking for about 15 mins about her son and how he's going to be her reason for living and to stop killing herself. It was a great conversation I never thought I'd have with somebody who was "tweaking" on meth for 6 days.

- Was a split second from getting into it with an ER TECH who told me I wasn't "allowed" to be part of a code because I was just a student and I was in "the way". A TECH, for those that don't know, are people that get trained for a few months to work in the ED assisting nurses/docs with little procedures, IV's, and basically filling any gaps. Let me just say that I'm a VERY calm person in the ED and I don't fight with people, or have an attitude and i CERTAINLY do not overstep my boundaries because after all, I AM learning, and I AM a student, and until I can master many more skills/knowledge, I don't think I, or anybody, should feel entitled or like we have some power over those on our team, regardless of our roleS or future role. That being said, I sooo wanted to kindly remind that tech that I've gone to more school than her probably 5 times over and that not only was I ALLOWED to watch, but I was actually going to be the one at the head of the table on this code (thanks to my awesome attending) and in a few short months, I would be the one telling her to get out of the way thankyouverymuch!!!!! BUT of course, I didn't say anything to her, I didn't need to really. I just took my coat off, walked to the head of the pt with my attending and proceeded to intubate the patient and call out orders to the nurses who are actually ALLOWED to put them in. After all was said and done in my head I was thinking "Take that ER tech, now who's not allowed!? In your face!!" lol...I'm a mature person, I swear. It's these little victories that make my days awesome! Oh and that intubation took a turn for the worse when he started vomiting black as I'm trying to see the cords...real nice. I ended up trying for about 6 minutes and was SOOOOOOO mad at myself (still am) when I couldn't get it. I felt better when the attending struggled before getting it though. Oh well, maybe next time! :)

- Chief complaint: "I'm high on crack. I usually take 100mg of morphine twice a day and I'd like my dose now and a cheeseburger."

- As I walk into the room to meet her for the first time ever, patient starts yelling at me "are you fu@*ing kidding me??? You aren't even old enough to know anything about kidney stones!".....I just told her i'd take that as a compliment and just turned around and walked out lol.

- Son of my above mentioned patient that coded and I tried to intubate, "I saw him lying on the floor for a couple hours but he's usually passed out drunk by noon so I didnt think anything of it. But when I brought him another beer and he wasn't breathing I figured I should call 911."

These are just a few reasons I love the ED and my life!

Song for the night...

2010-04-15T00:14:00.000-05:00

Post on the tri is coming soon! Crazy day, love this song! I always ask myself this about things in my life...

It must be an accelerated program...

2010-04-08T15:57:00.000-05:00

Crazy of the night...

CC: hand pain

I walk up to a 22 yr old girl in a hall bed and find her drawing organic chemistry equations on her sheets and giggling to herself...

Me: Hi S, what seems to be going on with your hand?

S: I'm working on my doctorate in chemistry, I have 1 year left, and this asshole in my lab spilled calcium oxalate on my hand today and it was burning and I just want to make sure crystals don't precipitate in my tendons.

Me: (trying to remember something about organic chemistry and decide if this girl is crazy or not) Oh ok, well i see that your hand isn't really burned at all, so that's good. Where is the pain exactly?

S: You aren't a chemist so you don't know the molecular composition behind anything but trust me, i've worked out the equations and i know my tendons are being saturated with crystals and I need calcium gluconate to bind them and stop the reaction.

Me: Nope, I'm not a chemist, but the strength in your hand is normal and judging from the little pain you have right now along with your normal x-ray and lack of burns, there doesn't seem to be any reason to think you have any damage to your hand or any need for Calcium gluconate.

S: Let me speak to toxicology and educate them on the chemistry behind this, you don't understand, I'm not leaving until I get calcium gluconate.

Me: Well, let me talk to my attending and we'll be back to talk to you. One last thing, where are you doing your doctorate?

S: Maricopa Community College

Me: .......nice.

First ED shift!

2010-04-06T02:57:00.000-05:00

So today was my first ED shift and it was awesome. To start off with, one of my attendings went to UF and is the VP of the Scottsdale Gator club and said he could get me cheap tickets to Gator games!!!! That just made my whole rotation from the beginning. But on top of that I got to do so much more than I thought. To sum it up, I did this today:

- had a patient tell me he tried to shoot himeslf but his gun jammed

- pelvic exam on a lady with a prolapsed bladder...that was weird.

- participated in a code/defibrillation (that was pretty scary and awesome at the same time!!)

- watched a crazy 22 yr old patient punch a nurse in the back of the head
- watched same crazy 22yr old patient get restrained against her will by the cops and in the process set off a schizophrenic in the hallway
- listened to crazy 22yr old and schizophrenic argue through the hallway about how who was going to kill who...for 2 hours.

- intubated a 21 yr old kid with severe asthma (also really scary)

- sutured a lady's head lac completely alone (the docs really trust me for some reason haha)

So I'm still really surprised I got to do all of this on my first day. I never thought they would let me do that much, esp on my first day, it was great. I think a part of it was that it was just a busy day and I got lucky enough to get cool cases today, but we shall see I guess. I'm working night shift for the next 2 days and I'm not so sure the middle of the night is that exciting. I'm purposely staying up late right now so I can sleep in late tomorrow haha...i can just see myself dozing off before I even have to be at work tomorrow! More stories to come I'm sure :-)

Getting ready for 4th year!

2010-04-05T01:10:00.000-05:00

So It's April! Where did March go??? This year is going by so fast already, it's scary. Before I know it it's going to be December! I was in Kirksville a few days ago for OMSIII testing, and wow...I don't miss it AT ALL!!! I miss my friends but honestly, you couldn't pay me enough to move back there. It served its purpose, and i don't mean to sound like I hated it, because I didn't. I appreciate the quiet beauty and convenience of the small town, but 2 years is enough. Also, there are a lot of bad memories that I would rather leave in Kirksville and not revisit. So I'm happy to say that the next time I go there it will be my most exciting trip to kirksville as well as my last...graduation!!! :)

In other news I have officially started my 4th year of medical school! I start my first ER rotation tomorrow and I'm really excited. THe docs I'm with seem pretty cool and I hope to learn as much as I can before I do my military rotations. I can only imagine the stories I'm going to get this month, I'll keep you posted! Also, I'm going home to FL this weekend to see family and do a short triathlon :) I'm not in the best shape for a triathlon, but it's a short race. I'm really excited for my family to be there supporting me, that has never happened before. I've never done a race in FL or close enough where family can watch, so I'm pumped about that. My dad already asked if he can follow me in a car...he clearly doesn't know how triathlon's work lol. ALso, Abbey is coming back with me!! I've missed her so much. She keeps me sane and I need her to take me for walks again.

So these next few months are going to be super busy for me. I have boards, which I NEED to blow out of the water, work my butt off on my audition rotations, and apply for residencies (i just got so nervous just typing that right now) lol. I know the rest of this year is going to be SO stressful, I can already feel it coming. I also know myself and how I can let stress overcome me and drive me crazy. So, one day at a time, that's my goal, for everything. I know I'm still going to worry/stress, but I can at least make a conscious effort to take it easy, enjoy right now, travel, experience new things and people while I have the chance. So much of my time is spent planning for the life I want in the future. That is a good thing, so long as I don't ignore the time I have in the present.

Song for the night: "wheel" John Mayer...one of my favorite songs.

Done with 3rd year of med school!!!!

2010-03-30T14:53:00.000-05:00

So I'm basically in my LAST year of medical school! I can't even believe that I'm this close to being a doctor, it doesn't seem real. Time really flies when you do a different rotation every month...the months seem like one long day and before you know it you're on to the next thing! I have a lot to learn in the next year ahhh!

Anyway, I'm going back to Kirksville, MO tomorrow for our last practical exam of 3rd year. It shouldn't be anything difficult, just seeing fake patients and writing notes on them. I'm not excited about going back to Kirksville, but I really do want to see some friends that are back there still. I'm only going to be there for a couple of days, just enough for me!

I'm pretty excited about the next few months though. Next monday I start my first Emergency medicine rotation and I can't wait! That's ultimately what i want to go into and I can't wait to finally be in an ER. I really need to get a letter of recommendation from an ER doc so I'm going to work really really hard and get the most out of it. I should def have some interesting stories from the ER in the next few weeks lol.

Also, in about 10 days I'm going to FL for a fun little triathlon on South beach. It's an ocean swim, which I've never done, but I'm excited to do it. I'm the most excited about the fact that my family will be there to watch me. Nobody in my family has ever watched me race or anything just because I've never done anything in FL lol. Also, the race is through the beautiful south beach and should be really flat and an awesome time. I'll miss a few days of the rotation but it's ok, it's totally worth it. I also get to go home and see my little abbey!! I miss her so much, she's most likely going to come back with me. :)

So the next few months are going to be fun, busy (not like that's anything new haha), exciting, and even scary at times I'm sure. And even crazier to think about, is that I'm going to know if I matched or not by Christmas! Ok i won't think about it yet because I can feel by blood pressure rising lol. But really, no matter what happens, i'm sure it will be fine.

Oh here are some pics of my most recent mountain biking adventure...we'll just say I took on the steep downhills and lost :)

Thing's I've done on Internal medicine..

2010-03-16T18:39:00.000-05:00

So internal medicine is the aspect of medicine, other than EM, with the most variety. You see cancer patients, crazy patients, trauma patients, surgery patients (sometimes if the surgeons let you), the sickest of the sick, and even the guy with an ingrown toe nail. It really is interesting to learn every aspect of medicine, but sometimes it's a thankless job. Here are some of the things my intern and I have done over the past week...

- examine prisoners as we're getting whistled at by his "roommates", one of which literally was taking a dump on the floor for attention, it was nasty to say the least

- Sat with a 34 yr old woman with aggressive, stage 4, metastatic breast cancer and held her hand while she threw up nothing but bile for 20 minutes straight.. and when she was done, told her that her cancer was in just about every organ of her body and going to kill her before 3 months was over and we needed to talk about hospice. That was terrible morning.

- Convince an old lady with severe peripheral vascular disease, diabetes out of control, and an ulcer down to her heel bone, that it's better to live with one foot than be dead with both feet. Sounds kind of insensitive, but if she kept refusing surgery to take out the infections she was going to get septic and die. It was sad because she literally didn't grasp the concept that pills couldn't fix her mangled foot. Sometimes you have to be blunt to get their attention.

- Got yelled at by an angry old man who has been traveling to hospice centers around the country telling them he is a prostate cancer patient. Was told that I'm too young to understand medicine and I needed to learn how to treat my elders. Turns out he doesn't have cancer, he had a failed penile implant which resulted in urethral damage and the removal of his prostate. He's been getting narcotic pain meds for his "cancer pain" in 6 different states and has now landed in Phoenix AZ after following/stalking one of his hospice nurses. He was discharged real fast!

- Witnessed how powerful the bond is between latin families. I know first hand out close knit hispanic families are, everyone is involved in everyone's business. This can be good and bad. But in the case of my patient who is a very sick lady, in the hospital for 15 days now, previously septic with salmonellosis, c. diff, DVT, pneumonia, severe bleeding problems, and heel ulcers from crappy nurses, her family has literally kept her alive. I'm convinced that the medical intervention we provided was just important for her recovery as was her family. She literally had 5 people with her at all times (in a room with 4 other pt beds) and a daughter who fought to sleep in the room with her, on a wire chair. They may not have insurance or money or the knowledge to really know the severity of her condition, but they were grateful for us and everyday, no matter what happened or if they never slept. And they were sure as hell were not going to leave their mother alone. I love that, if only more families were that way.

2 more weeks of medicine left. I'm learning so much everyday and constantly blown away by people...in amazing and horrible ways.

Pesa mas la rabia que el cemento

2010-03-16T00:26:00.000-05:00

This is my favorite Shakira song. It reminds me of one of my best friends. Fitting for my mood tonight...which is more difficult to handle, anger or sadness?

p.s. I got a new camera...pictures coming!!

Recent events...

2010-03-12T22:51:00.000-06:00

So thing's lately have been stressful. I know I tend to over react about certain things, but the most recent cause of my stress, politics and beaurocracy, are not things I take lightly...ESPECIALLY when they directly impact my future. Long story short, I'm being penalized for mistakes made by another student and being forced to stay in a rotation solely to "keep the preceptor happy" and maintain good rapport with him and my school. I've raised hell as much as I can, within reason, and fought for the principle of the matter. I've been so stressed about it and frustration with the system has given me motivation to keep fighting for what I know is right. Unfortunately, in the world we live in, and the context of this situation, I have to give in. It's incredibly frustrating to know this happens all the time, and it seems like it always happens to me. All because people are afraid of standing up for what is right and it's easier to fly below the radar than make a difference by speaking up. I had the same issue when I was in the AF. People are more worried about their image and "looking good" than doing the right thing. Unfortunately, as much as I hate to say it, that's the way it goes. In my situation now, I'm forced to give in. I'm just a student, I have no real pull one way or another when I'm up against my superiors. All I can do is cut my losses and realize that sometimes you have to know which battles to fight and which to leave as is (no matter how much it kills me!) I can just remember what it feels like right now and when I do have major pull one day, vow to do what's right, regardless of how unpopular or difficult it is.

Throughout this ordeal I've realized that I need to find a better way to really relax. I've used running, swimming, and biking in the past. It has for sure helped in the past, but here recently it's not working as well. There are other family issues that I've been dealing with also, in addition to med school stress. I hate complaining because I know A LOT of people have it much worse and I really am very very lucky. But nonetheless, I have had a lot on my mind and i feel like I haven't felt at ease for a while. I never really realized how much worrying/anxiety takes out of you physically. My run's have been slower and my muscles just overall felt weaker. I wake up every night at 2:30 and 4am for some weird reason. Hell, my mind is so all over the place that last week i forgot to eat and almost passed out at the rock gym! :(

So, I realize that I'm sounding like a whiney baby right now, and that sucks. BUT, i'm happy to say that today was a GOOD day. My frustrations with the school issue is resolved for the most part and I've mostly accepted the things I can't change and hope things turn out well, they usually do. I have some peace of mind now that I've decided not to re-take my USMLE (med school boards) again...a cause for a lot of stress considering my test taking abilities. And I'm starting to feel better now that things at home are calming down again and my family is stable again. As much as I hate the saying "things happen for a reason"...i find myself thinking that a lot. In the past when thing's have seemed to be going totally wrong in my life, it turns out better than I could've ever planned. And man, I am quite a planner!

So as to end this kind of Debbie Downer post on a high note...here are things that I'm super happy about:

1. I secured a international rotation in Bogota, Colombia at Fundacion Santa Fe de Bogota! Not only is this a sweet hospital, it's the same hospital my cousin's medical school is affiliated with! This was a total coincidence, it just worked out that way :)

2. My cousin is moving to Arizona in about a month! I'm so excited to live with her and explore AZ and the west coast with her!

3. Despite the stress, I'm exactly where I want to be right now! It's easy to be lonely and question the future and wonder if I'm ever going to meet somebody who is willing to accept my AF life decision, among many other things. But to be honest, I have so many other things occupying my mind right now that I'd rather not put energy into being lonely. One thing at a time...

So that's a long post! Next post will be less depressing, i promise.

Song for the night: Adele- Hometown Glory

"No and thank you please Madam, I aint lost, just wandering..."

Is it bad that I do this dance in my head almost daily... haha

2010-03-06T00:30:00.000-06:00

So my mom calls me "sabe-lo-todo" which is the spanish for "know-it-all"...and she hates this dance.

One day I'm actually going to do this in the hospital...

Internal Medicine HIGHLIGHTS!

2010-03-04T22:21:00.000-06:00

So I'm back at Maricopa County Hospital...it's pretty much my favorite hospital in the Valley. It's a state hospital so it's ghetto, totally old school, and serves most of the valley's mexican population, prisoner's, homeless, and immigrants. For this reason, you see the most pathlogy and some of the craziest/sickest/grossest people in AZ haha. The system that the hospital uses as far as charting is pretty archaic and slow. But it's a great teaching facility and definitely has some of the BEST and SMARTEST doctors working there.

Here are some of the highlights from my first week:

- Man admitted for complicated UTI because he cut off his penis and testicles at home with a kitchen knife. The voice of God told him to do this 1 yr ago and he has major reconstructive surgery to "repair" the damage. He is now prone to UTI's.

- Met my first hoarder... she literally pooped, ate, peed, slept, etc in the same spot for weeks.

- I smelled MRSA for the first time. Was examining a homeless (hadn't showered for weeks) patient's wound (on his stump, below the knee amputation) and the attending asked me to describe the smell...i thought he was kidding...he wasn't. I also almost threw up in my mouth.

- Did my first lumbar puncture, completely solo! Interns screwed up the order from the previous day and the HIV doc (the pt actually had AIDS) needed more tests....so he asked if I wanted to do it....so I stayed an extra 2 hours waiting to do it! It was a bit scary knowing I could paralyze the guy by sticking a long needle into his spine. BUT...in the moment you forget about everything...and i got it first time! Not even any blood in the first tube :-)

- Realized that Internal Medicine is NOT something I want to do. I find myself being drawn down to the ED every chance I get. Medicine is interesting, but I don't like to follow up on people that much lol...I'm over a patient after a couple of days. Not that I don't like to see people get better, in some cases i like to follow their hospital course and see that my treatment helped...but I'm satisfied with being the first person they see and being done with them thereafter.

- Surgeons are still a-holes, no matter where you go.

- I'm amazed at how many people in this world don't actually use their brains. (i'm not talking about patients)

Ok well those are just the main points from this week! I'm sure i'll have more coming soon!

Lots of things!

2010-02-22T14:58:00.000-06:00

So i was going to start off by saying that I'm pretty stressed out these days, but then I realized that being stressed is my norm. I know no other life but balancing a hundred things at once, working hard, and planning for the next step. And really, almost everybody on this earth has stress of their own. So, it's more accurate to say that I'm doing my usual! Which is extremely stressful at times...but more times than not, its just the usual stress that is life. :)

A list of the things I'm currently working on:

- Setting up a rotation in Bogota, Colombia- I'm getting somewhere now i.e. I have a hospital that is willing to take me! woo hooo!!

- Planning my 4th year rotations- aka deciding where and what i'm going to be doing for the next year of my life (eek!)

- Facing the fact that I'm going to retake one of my board exams (this thought makes me physically ill) to improve my chances of being accepted to a non-Air Force Emergency medicine program...this is worst case if I don't match with the AF...but my life works in worst case scenarios...so I'm planning for anything that could happen :)

- Training for a triathlon on April 11th- Nautica South Beach Tri! This includes weekend rides with team strada, running, swimming, and rock climbing (the climbing is for cross training)

- Studying for Step 2 of boards, Internal medicine shelf exam, Core shelf exam, oh and that USMLE Step 1..again!

- Trying to enjoy life as it comes

-and last but not least...not going insane! :)

So that may not sound like a lot and frankly I know people that do all of this and then some. I'm also super lucky (or maybe unlucky?) that I only have to worry about myself right now. Planning one medical career and life is complicated enough without having to incorporate the life of my family in there too...I can only imagine how tough that must be. So for my peeps that do it all...you totally rock more than you know ;-)

ANyway, despite all of the possible "what if this doesn't happen" or "what if i don't do well on this test or match at that program", I really am just telling myself that I've been here before and it has ALL worked out. I've been there when nothing I planned for happened and everything I thought was going to happen, never did. No matter how much I scrambled to make it happen, it just wasn't in the cards at the time. Getting stationed in NM to do the opposite of what I was studying, not knowing anybody, and seemingly straying farther away from my medical school dream was the worst...or so I thought at the time. I have deja vu now from that now. I'm not at that point, but I remember it well and am doing the same "scrambling just in case" dance so that I don't even approach that feeling of being stuck again. Even still, if I do end up back there and things pan out totally different than I have been planning...I at least know I covered my bases and that it REALLY WILL BE OK. The worst feeling of helplessness back in NM brought the very best opportunity in my life and got me where I am now. So I'm trying to keep that in mind and not freak out lol. So here's to spending a little less time freaking out and less time making back up plans for my back up plans. Enjoying the right now!

Thought for the night: Passion!!

2010-02-14T23:24:00.000-06:00

So watching the olympics the past couple of days has made me think a lot about passion. I love the olympics because no matter how different the events are...like curling lol...i think its absolutely awesome how passionate all the athletes are about their sport. In my eyes, there's nothing more sad than people who don't have a passion for something. A person with no enthusiasm for anything is boring. I've known people in my life that don't get excited for anything, don't really care much about anything, and even admit that they aren't really enthusiastic about most things in life...who wants to be around people like that?? I'm not saying people have to be excited about life all the time. But everyone should have something they love right? Something that makes them who they are? Now this shouldn't be a spouse (obviously you love your spouse), or sex (that's obvious), but more like a hobby or a cause, etc. It doesn't have to be something big...be passionate about underwater basket weaving, but that's something! I hate when people are afraid of doing big things or going all out for fear that they will be judged because they do something "too much". Who are you to discourage others for doing what they love just because it's not what you love? My favorite dave matthews song says "Some might tell you there's no hope in hand just because they feel hopeless, but you don't have to be a thing like that" and its totally true.

I get frustrated with friends that tell me i need to "calm down" with some of the things I do. "Too much isn't good".....that's what people sometimes tell me. Really!?!?! Since when is enthusiasm not good? I'm sorry but I'm really not interested in the mundane, over simplified, don't get excited about much kind of life. It's extremely hard for me to understand how people can go through life and not really care and be excited about at least one thing. Maybe they don't allow themselves to or somebody discouraged them. If you're not excited...why even do it? I tend to throw a lot of emotion into just about everything I do, sometimes it's a bad thing, but most of the time it's awesome. Sure you can be disappointed by getting hopes up about something and there's always the chance that you'll fail. But one of my bosses once told me that if you don't get you're hopes up in the beginning, you've already given up.

So no matter what it is you do...put your heart into it! Even if its something you think nobody likes or is nerdy (i have many of those nerdy passions), or is not popular... be confident, be passionate! Be like the curling people in the olympics who's life goal is to slide a huge silly weight across ice and be the best at clearing said weight's path...they win gold medals for that and its awesome!

Ok that's my thought for the night...off to bed so I can practice my passion tomorrow as I wake very sick people up in the hospital early as hell and ask how they are feeling. lol

Adele - "Right as Rain (Live)"

2010-02-10T00:49:00.000-06:00

Love this song right now...

Adele - "Right as Rain (Live)": "Adele performs 'Right as Rain' Live and Unplugged"

Planning for Colombia :)

2010-02-08T11:15:00.000-06:00

I've been trying to plan out my 4th year the past couple of days and it is STRESSFULL! There are so many rotations I want to do and not enough time to do them all. The other thing that is causing me stress is planning my rotation in Colombia. I'm pretty sure I want to do a pediatric rotation. Everytime I go to Colombia to visit I always get so heartbroken by the children wandering down the street, in traffic, selling gum to make some money. I always end up buying their whole supply as soon as I see them and end up giving them extra money to go buy themselves ice cream lol, those kids LOVE ice cream. Since I was a kid I can remember giving them my whole stash of pesos that my parents gave me...they always got mad when they found out i gave it to the kids on the first day lol.

But when I go back for my rotation I really hope I can finally do something more for them. Setting up the whole things is somewhat of a production, since it is sort of difficult to call Bogota and get in touch with somebody, not to mention the right person who can actually help me. BUT, i know it'll be TOTALLY worth it. It has been 5 years since I went to the Dominican Republic on the medical mission. That trip was a complete life changing experience for me and now drives my dreams of doing third world medicine. It put everything in life back in perspective.

Here are some pics of Bogota, Colombia!

Top of Montserrate looking down on Bogota! It's beautiful there.

University of Los Andes- The school/hospital I'll be working with; also my cousin's medical school!

My aunt Teresa and a little guy we met while hiking in the mountains living with his family. We dropped off food and clothes for them. He was born in that house and has never been seen by a doctor...ever! He's the reason I want to go back!

My favorite kind of patient...

2010-02-04T23:56:00.000-06:00

Dr. R: "So i see you had some chest pain last night?"

Mr. L, 70 y/o marathon runner: "yea i thought i was maybe having a heart attack, but i'm fine now, i think I just ran too hard."

Dr. R: "It doesn't look like a heart attack, but we have to get one more set of results back, but you can go home later today."

Mr. L: "Today huh?"

Dr. R: "Yup, any more questions for right now?"

Mr. L: "Can I run tonight, I have a track workout planned."

I never get tired of these patients! This guy was pacing the halls in his robe and Saucony running shoes just itching to be cleared, and I loved it! I love it when people are actually involved in controlling their health and staying active. He looked like he was maybe 60 and could def run circles around me. I ended up going back and re-iterating how important it was for his future races that he rest for the next week. But I know how he feels!

Maybe I can be like that one day! Afterall, it was a pack of a few 70 yr old men that got me through my first marathon. They kept me going the whole way with dirty jokes and all! I love old runners :)

"I regret my regrets..."

2010-02-02T19:07:00.000-06:00

I just started on internal medicine 2 days ago and already I love it. Doing the medicine and thinking
through/learning the pathophysiology of everything is really cool but it would eventually get boring
without the occasional patient that brings you back to reality. I def don't know even nearly all there is to
know at this point...but I know enough to get into a dangerous "routine" as some docs call it. It's really
easy in medicine, once you do it for long enough to reflux orders, tests, and treatments...to become
somewhat detached. Sometimes on a rotation that is really fast paced (like this internal medicine one right now) I catch myself getting bogged down with the routine. Most of the time I can realize it and take a
step back and remind myself that the little things matter just as much to people as the big things.

We had a patient today who, in short, asked us if we could give her a "shot" so she didn't wake up. She
later told us that she wanted to go home and drink all the beer in her house to just end everything. While I def can't understand what she is going through, I couldn't help but think how ironic it was that she was so sad and hopeless about her condition, but the only thing she wanted to do was the one thing that
seemed to primarily lead to her current state. She went back and forth between crying and joking, but it was clear that was how she dealt with knowing she was at the beginning of the downward spiral that is Hep C, cirrhosis, end stage renal disease, lung cancer, and many more health problems. She definitely
snapped me back to reality and made me think about the choices we make.

My most memorable patient so far, a guy in his late 50's, dying from pretty much failure of every system in his body because of drug/alcohol use in his past once told me, "I regret my regrets". You'd think he was miserable, crochity old man who just was better of dead...right?? Wrong, this guy was the happiest,
most peaceful, and one of the most inspiring people I've met. Not because of his past, but
because of his outlook on the choices he made in life. At first I wasn't really understanding what he
meant by regretting his regrets. I've always been torn. Am I of perspective that we learn from everything in life, good or bad, so its best not to have regrets...learn the lesson and move on? Or that its ok to regret
things, as long as I regret the right things. But after knowing him
for a short while and having him tell me all the time that life was about choices, the good ones AND the bad ones (and he def made a lot of terrible ones lol), I realized he was the ultimate testament to having no regrets. Riddled with disease, he loved every minute of his life, even at the end. He had choices, he made certain ones that ended a certain way, but he was happy with that. I don't know that I'll ever be able to honestly say that i have no regrets, is that even possible??? But he definitely taught me that life is about
choices, standing by our mistakes, owning up to them, and not letting them bring you down.

So today I was definitely brought back to reality to say the least. It's not everyday that I have a patient
politely ask to die. Are we making the choices today that we're going to be able to accept
tomorrow?? Maybe we'll never know until we're there. So for now, I'll just try to only regret my
regrets...

Something I wish I could say to people almost on a daily basis...

2010-01-25T00:24:00.002-06:00

I wish this actually turned out this way...

2010-01-24T23:58:00.000-06:00

I am crazy in my own way, have soo many quirks about my personality, overthink just about every situation, am incredibly awkward with men, and am almost impossible to handle at times. BUT...that's me :-) If only i could say this all to a guy and have it end like this lol...

"I'm selfish, impatient, and insecure. I make mistakes. I am out of control and at times, hard to handle. But if you can't handle me at my worst, then you don't deserve me at my best."- Marilyn Monroe

kind of cheesy...

2010-01-13T00:54:00.000-06:00

So I love this song although its kind of cheesy and corny unlike my usually cynical self. And this video I found with it just makes it super cheesy, but I love it! I have my moment of weakness/girliness from time to time lol

I've decided...

2010-01-05T21:09:00.000-06:00

Today was my first day of pediatrics in Surprise, AZ. I wasn't sure how I was going to like it but after today I've decided I LOVE LOVE LOVE the kids...but I can't stand their high maintenance moms. I have always loved kids, all ages, EVEN the criers. I know I'm not seasoned at all in medicine but I do have days where I absolutely hate adults. I hate it when all my efforts to try to help are wasted on people that don't listen to you, only do more damage to themselves, and don't even care to get better! Granted, I understand that everyone deserves unconditional help, even at their lowest points. But some days its incredibly hard to help people that won't help themselves. So, today when I walked into my first patients room, a 5 yr old well child check, and he ran to me, hugged my leg and told me he loved me, I decided I love the kids. It happened several times today and I was shocked how much I absolutely love being around them for this reason alone. Without knowing who I was, without ever seeing me before in their lives, they trust. They're so pure, they want to feel better, they don't hate you for trying to help them. That being said...I'm not such a fan of the moms. I just can't seem to grasp how you can actually dial 911 because you're child has a cough and spit up...really?!?! I can understand (to an extent) that motherhood is something amazing and your love for your baby makes you over worry, over react, etc...but does it make you an idiot? (sorry if that was insensitive) But is it really necessary to cry because your child sneezes 2 times in one day? (yes all these things happened today.) On the other hand, there are the moms that bring their kid in because his eyes look "weird"...and he actually ends up being diagnosed with congenital glaucoma, also happened today. And then there are the moms that refuse vaccines because they don't want their kids to have autism...I guess your risking measles is a better choice...."i read it on the internet..." People are very strange and different and I will never understand why people do the things they do. Regardless of the crazy parents, the kids are worth it.

On a cooler note, I got to do a circumcision today! It was pretty cool except for the part where the dad almost passed out. I guess they feel it in a different way than I do lol.

So we'll see how tomorrow goes. I'm starting to like the idea of pediatric emergency medicine, that would be pretty sweet.

Vacation is over...back to my crazy normal life!

2010-01-03T12:48:00.000-06:00

The 2 weeks I spent at home went by at a good pace this time. Usually I complain at how fast the break went by and that I wish i had more time. Maybe this break was just right because I actually let myself relax and not feel guilty. When I come home I find myself running every single day, making sure I see everyone so they don't get mad, doing something productive with school, etc. I just relaxed, still ran a lot (that i can't stop), and didn't feel guilty for sleeping in past 8am. Also, this break was different because of things that happened. I ruined my brother's engine in his 3 month old car (it was an unavoidable accident, but still sucks a lot) and had a couple big disappointments with friends/family. I definitely enjoyed the break and the chance to recharge but it was somewhat emotionally stressful. I learned some pretty good lessons about family and friends when I wasn't busy trying to fix the mess i made with the car, only I can find a way to lock up a BMW engine with water, awesome.

I also got to see some friends from college that I hadn't seen in 4 years. Went to two of my very close friends' wedding yesterday in Pensacola and had a great time. The wedding was awesome. I'm just really still getting used to the fact that most of my friends are married or engaged. Is it really that time already? I'm going to be that 50 year old lady still swearing that I'm too young to get married haha. I especially love it when I ask my family what their new years resolutions are and they say "for you to meet a nice boy and get married"...nice. Maybe they don't understand the concept of new years resolutions.

It's also scary how fast 2009 went by! It was a good year for me, mostly because I got out of Kirksville and moved to Phoenix and because I'm finally doing what I love...in a hospital! I remember for so long thinking that rotations were way down the road for me. And now knowing that I have to start planning for residency, and finally being a doctor (although i may still feel like i know nothing) is pretty unreal. 2010 is going to be awesome and I really want to take advantage of my last year of "freedom" and travel for my rotations. Hopefully I can land a rotation in Colombia, Hawaii, and possibly NY.

But anyway, normalcy starts again tomorrow bright and early with screaming kids. (Pediatrics rotation starts tomorrow). I really love kids but I don't know how I feel about being their doctor, we'll see. It will either leave me wanting to have kids soon or never wanting kids...either way, it should be interesting.

The highlights of my surgery rotation at Maricopa Medical Center aka "da copa"

2009-12-31T14:17:00.000-06:00

I've been meaning to post this but I always forget!

So for the past year I've kept a little notebook of thoughts/quotes/ideas/tricks that I learn on each rotation. I write down things, not really notes, but things that I learn from and go back to. Whether its a new enema recipe that I hear an old doc talk about that works every time for ileus or constipation(yes this is cool to me), or a moment that I really don't want to forget, or just some funny quotes from patients, I write it down because I want to look back years from now and hopefully bring back some humility. I want to know that even if i gear towards being a "know it all" doc or even somewhat cynical, i still can remind myself that I was not so savy once and to not lose sight of the little things that really matter and where I really started. Ok so anyway, this post is just to share some of those quotes that i wrote down....

In the ER:

Chief complaint- testicular pain/infection
Pt with testicular abscess: "Doc I'm pretty sure one of my hoe's gave me the shit!"
Me: "We're talking about your testicle right?"

Chief complaint- possible small bowel obstruction
Me: "Do you have any history of high blood sugar or do you take insulin?"
Pt who is barely awake: "no, i've never been sick"
Pt's brother: " She's been great, her sugar was a solid 379 this morning, like it always is"
Me: "........."

Chief complaint- rectal bleeding
Me: "has this ever happened to you before?"
Pt who is clearly is too high to remain awake: "oh no, i'm very healthy, not one health problem"
Me: "hmm, what color was the blood?"
Pt, awake again: "oh here, i saved a clot for you so you could see it!!" [shoves tissue with blood clot in my face]
Me: [trying not to vomit] "that's ok, i really don't need to see it....."
[I stepped out after doing her physical and read in her chart that she has HEP C, she's MRSA+, and positive for every illicit drug on the planet almost. Nope, not one health problem!!]

On the Med Surg Floor:

Chief complaint: leg abscess
Pt who made it through the ER fast because she was demanding surgery on her leg abscess: "Hey doc i just need you guys to go in and drain my site, it's infected again, and it's my only site left"
Chief resident: "Site? you mean your shin?"
Pt: "yea if you don't do it tonight I'll go through withdrawals again, that's how I wound up in the ER, and I really don't like shooting up in my neck"
Chief resident: "ok well thanks for your honesty!"

S/P diverting loop colostomy
Me: "how are you doing this morning? how is that colostomy coming along?"
Pt with Stage IV colon cancer: "well, if i have to have to wake up to talk to people about my shit at 5am, I'd rather it be with pretty girls like you, at least I know if this doesn't scare you away, I still have hope"
Me: "It takes more than some shit in a bag to scare me away..."
Pt: "well I've got a lot of shit..."
[he was my favorite patient] :-)

S/P perineal reconstruction with abdominal flap and total proctocolectomy aka a huge operation and she almost died
Pt, 3 days out of surgery: "I'm going to be fine, don't worry"
Me [almost in tears that she is comforting me, came to tell her it was my last day of the rotation and I wouldn't see her again]: "It's my last day with you, but you have the best doctors taking care of you and you're going to do great"
Pt: "thank you for taking care of me, never give up, I love you"
Me: [balling my eyes out like an idiot]

Presentation in weekly Morbidity and Mortality conference [ this is where interns and residents present cases that had a negative outcome due to a preventable reason and they get torn a new one by the attendings, very scary]
Dr. O: [presents a case about a pt who had a tear in his esophagus repaired, and then had to return to the ED because the repair failed and tore open again] "the failure of the repair was due to the patients diet immediately post operatively"
Dr. G (an intern, not the sharpest tool in the shed): "actually, It wasn't Dr. O's fault, it was mine. I gave the pt a sandwich the following morning and asked him if it hurt. He said no, so I thought it was fine."
Attending Physicians: [first silence....then the lions unleashed and attacked poor Dr. G]
Dr. G: "...but it wasn't the whole sandwich, he just had a couple bites!!!"
*note to everyone- if you have a hole in your esophagus and then have it surgically repaired...DON'T EAT A SANDWICH THE NEXT MORNING!!!
*note to self- do not yell back at your attendings when they are yelling at you during M&M...they WILL kill you. And if they don't, your fellow residents will.

So those are just a few of the quotes/moments from my rotation that I wrote down. It wore me out, made me cry, made me feel like I was dumber than a pre-schooler at times, and made me feel stronger than I ever imagined other times. It really is crazy how far we've come but even more crazy is how much more ground we still have to cover. I don't think it ever ends. Actually, I hope the learning and pushing limits never ends. Oh yea, and saving lives is pretty dang cool too...

I look at people's butts before 5am...

2009-12-09T21:40:00.000-06:00

So it's been a while since I've written anything in my blog. I've been really busy! General Surgery at Maricopa Medical Center in downtown Phoenix takes up about 16 out of my 24 hrs in the day. Although I have to wake up at 2:45AM every day, drag myself out of bed, smell cauterized flesh and colostomy bags before breakfast, endure heartburn from endless coffee and no food until about 3pm...i'm loving the rotation! At first I was really unsure if I would enjoy it at all because I really didn't think I would enjoy surgery. I'm always cold, i can't stand for long periods of time, and I lose interest in a case after 2 hours, maybe that's just my ADD. But to be honest, it's been great. I love the satisfaction that you, the surgeon, are the one that does the final intervention. And it's not that I like the whole "I'm God" feeling at all, i think i have an aspect of my personality that wants to fix things...and as a surgeon, you do exactly that with your hands. But at the same time, I don't know that I like surgery enough to want to endure the residency/lifestyle. If I did do surgery, trauma surgery would probably be where I'd go, but that's just insane (which I am at times), but i'm still leaning towards ER, just ER.

So far i've learned so much on this rotation. Def learned stuff about medicine itself, but mostly I've learned about dealing with people. This is hospital is so big and busy all the time, people in the OR just move at a faster pace i think, well my team does. In the midst of all the bustling and million things that need to be done I've found myself easily forgetting about the patient itself. People are always paging, calling, ordering, yelling, etc. They always tell us in school to have compassion, sensitivity, always treat the patient how you would treat family. And i've always just thought "oh yea well duh, i'm not a jerk, i'm never going to forget to have compassion, etc etc etc..." But in the past 3 weeks alone i've had to catch myself and actively think to do all of those things they tell us in school. I find myself in the OR trying to get op notes, admit orders, set up the meds so fast so I can be more efficient and move on to the next case without delay. That's fine and all, but today I realized that i was just falling into a routine. A routine that really didn't include, make sure patient isn't afraid, and look for the little things that make a big difference (warm blankets, reassurance right before/after anesthesia, etc). When i'm in lecture its easy to say I'll do all of those things. But when you're in the OR and in that environment, I can see how people easily lose that aspect of medicine. I'm going to try my best to realize that now is the time to form the right habits and that no specialty is too busy to do the right thing and go that extra mile for the people we take care of.

On a more inspiring note, I almost cried today in front of a patient. Ms. AC is a 55 yo lady who weighs about 80lbs, has crohns disease with active colitis, the beginnings of colon cancer, and severe perirectal fissures and abscesses. She's in so much pain that she can barely move when I see her at 4am everyday. She gets food by IV in addition to normal diet because she's so malnourished. Her eyes are sunken and her arms and hands are just bones with red nail polish. She is a very sick lady, but also one of the sweetest people I've met in a long time. She will most likely need her colon removed along with the region of skin and muscle around her rectum and will need subsequent reconstruction of her anal canal, and chemotherapy, which may only make her worse. She has a very rough road ahead of her. All that being said, I went to see her today in the evening before I left to explain the surgery plan. I explained the entire extreme plan, the risks, possible consequences which, to me, makes me cringe just thinking about the recovery and overall outsome. And after I got done telling her what seemed to be like torture, all she said was this "vayamos todos adelante, nunca para atras". It means "let us move forward, never backwards". Even after I told her that she mght die from the surgery and treatment to try to save her life, she just smiled and still was positive. She then said "I could cry, but for what?" I felt the tears sort of welling up in my eyes as I just looked at what almost looked like a skeleton smiling back at me. I was thinking "i hope that I one day have as much strength as this lady". It's remarkable how some people are resilient beyond belief and no matter what, remain hopeful and strong throughout. They're the ones I really love to serve everyday. And then you get those people that don't appreciate anything you do, only complain, and make decisions to worsen their condition everyday. I don't think I'll even understand it and it really frustrates me. But if for every 20 frustrating patients, there's just 1 patient like Ms. AC, that's good enough for me.

So, my surgery rotation is awesome overall. I'm amazed my the dynamics of personalities, perspectives on life, and just plain old social skills that some people lack. But more than anything, I'm learning that no matter how big, how smart, how awesome I think I am, I will never be above doing the little things, i guess it's that extra mile that really matters in the end.

Bed time for me...i have bellies to push on and colostomies to check in the morning!!!

Weekend...

2009-11-15T22:02:00.000-06:00

So, its Sunday and I'm just as tired as I was on fri after work! How did that happen? I did a lot this weekend. Went to the gator bar on saturday with mike, mara, rohan, ali and others to watch the gators kick butt, it was fun, always is. After eating out weight in nachoes, chips, wings, and skillet cookie and ice cream we went back to mara's to work on a med school thing...it turned into this:

Yea...we got distracted with my photobooth program on my mac lol.

I got a chance to go to the AZ cardinals game this weekend which was pretty fun...my first NFL game!! Tailgating and eating junk food was pretty awesome. I also learned that I'm good at ladder ball! The only bad thing was that it took about 8 hours out of my sunday, which i'm sure could have been used for studying, oh well.

This next week is my last week in OB! I'm a little sad but I'm looking forward to not being sooo busy all the time and def not driving so far everyday! I'm going broke (more than i already am) driving to Sun City West! Surgery at County hospital is next. I hear its long hours on your feet, which i hate, but cool experience, which i love! I'm not into being a surgeon, but I am looking forward to learning how to be better at tieing sutures. Hopefully it's not a crazy month.

In other news, I was kind of let down by somebody this weekend. Nothing serious really, but it blows my mind how some people can fool you into thinking they're somebody they're not. You'd think we'd see it coming? I guess it comes with time, and then again maybe it won't. I really do try to give people every benefit of the doubt but sometimes that comes back to bite me. I've definitely stopped being as naive as I used to be, but a part of me I feel like is too trusting sometimes. I guess I'd rather be trusting while still being cautious and get fooled from time to time than be completely cynical towards people. It's tough to find a balance though when you feel like the number of "good people" you know is decreasing all the time. So i'm still not that cynical people hater that thinks people are jerks, but I'm def very very cautious.

Here's my song for the night.

Imogen Heap- First Train home

"...what matters to you, doesn't matter to me..."

I seem to know nothing...

2009-11-09T22:52:00.000-06:00

My Ob/Gyn rotation has been pretty awesome so far. I love the mix of surgery and clinic experience along with the continuity of care. But probably my favorite thing is that your patients look forward to seeing you. The tone is very different in OB and for the most part, you bring good news everyday. It's def my second choice, after ER. I still stay true to my ER :-)

So as we go on all of these different rotations and learn so much more everyday...I still feel overwhelmed on the days when I hit the wall. The wall that is the limit of my knowledge that really makes it clear how much more learning I have to do, and how little I still know. As med students we can learn pretty quick and adapt to a new skill after a couple of tries, but today, I couldn't help but feel like "holy crap, will I ever be good at this?!"

I was put in charge of a delivery, with the doc watching over me of course. I had to coach mom through breathing and pushing...luckily she was a G5P4 and it took all of 2 pushes to get the baby out. But the scary part came when the doc told me to think through it and get the baby out on my own. So there I was trying to count and freak out at the same time. The head crowns and I"m thinking ok no big deal, check for nuchal cord, suction baby, pull down for shoulder, pull up for next shoulder.....of course this one was difficult. The baby had a VERY TIGHT nuchal cord that i couldn't reduce and i looked at the doc and he looked at me like "ok what do you now??" In addition to freak out, i gave him the "holy crap you actually meant i'm really doing this on my own" look back. So when I asked about all of the things i could maybe do to release this cord and got the answer "try it", I got the impression he wanted to see me struggle. So, tight cord, doesn't reduce, i try to just get the baby out. In a quick thought I looked at the doc and asked if i could just cut the cord...but of course, "no don't even think about it!" Crap. After a few seconds, that felt like 5 hours, of "thinking" my way through the delivery, baby slides out and was fine. A little quiet at first because of the cord, but overall baby is good and I'm drenched in sweat! The doc tells me I did a good job and says "ok now the hard part"...repairing the secondary laceration...awesome, as if i wasn't already shaky!

Anyway, after all of that I'm pretty relieved that it went well and actually grateful that doc made me sweat a little. The toughest part of this stage in the game is thinking on our feet, well for me it is. It's like all my knowledge gets erased, i freak out, and I seem to know nothing anymore...its all gone in an instant, just blank. I might as well be drooling lol. So i really appreciate it when docs make an effort to show us how to think in crazy situations. Even if i'm not going into OB, it's a great skill to be able to step back in your mind and think through a problem with all the information floating around in your head. Woman screaming, monitors beeping, nurses asking questions, doc staring at me, blood everywhere, vagina tearing...it was stressful!! And through all of that, i'm supposed to be calm?? I guess the more you do it, the easier it gets to drown out everything but your thought process. One day I'll be able to do that...hopefully sooner than later. And hopefully that feeling of "holy crap I know nothing", starts fading. But until then, baby steps, trying not to let a pimp question erase my memory of

everything i've learned!

Thoughts of the night...

2009-11-09T00:27:00.001-06:00

Since my last post things have been great! I started ob/gyn, which I have to say, I love! 70.3 is finished!! That was a huuge relief and great accomplishment I'm so happy I achieved. It was a big goal of mine and I actually surprised myself at how easily (i use that word loosely) I did it! Aside from the physical work that it obviously took, I'm more proud that I did it all on my own. That was one thing I wanted to prove to myself that I could do, train for that race alone and be self-motivated. Many days it was very very difficult to get up and go when i was the only one I had to answer to. It was just a race, but it really showed me that I could be self-motivated enough to do something I never imagined I could do. I figure that no matter who you have on your side rooting for you, at the end of the day, we always answer to ourselves. It's really important for me to know that no matter what I'm doing, where I am, or who I'm with that I can set a goal and reach it all by myself, if necessary. Granted, I had great support from friends and family...but again, in the end, for 6.5 hrs, it was just me and my thoughts on that course. I like to think this goes for a lot of things in life. No matter how much support you have, the only person you can always rely on is yourself. So, great things came out of that race, definitely more than just a good workout! Since then I'm just learning from that day and figuring out where I go now. 140.6 is a far ways away...or is it?? I'm still trying to figure that out. I do know that I need to stay focused on the big picture right now and all things come in due time. I know that I WILL do 140.6 one day, that I'm sure of. But for now I think I'll just keep at this level of competition, focus on school and wait for when the time feels right for 140.6, no rush.

So another thing this race was for me was that it brought me to a different level, change. It brought a new outlook on many things and took me out of my comfort zone and set a whole new one for me. I'm ready now to be more open to a lot of things I was really hesitant about. I guess you can say I'm ready to let go of old comforts and really try to reach for things I never really let myself consider. It's not as easy as it sounds, but every step forward, even with a few steps backwards, is progress!

This song puts it well...

Changes coming soon!

2009-11-08T12:26:00.002-06:00

So now that I've completed my list (minus 1) of races...i need to start over! I'm a little behind i updating my life status...rotations are keeping me busy!! No worries, its coming. All new races, goals, perspective, etc. So, i won't say much now but new things/blog changes are coming soon! Stay tuned...! :-)

The man who taught me everything about schizophrenia...

2009-10-21T22:52:00.004-05:00

So my rotation at the VA on inpatient mental health ward is coming to an end tomorrow. I'm not really sad, it's basically been your run of the mill PTSD, depression, anxiety, adjustment disorder with your occasional shizophrenia. The guys, I say guys because I think i saw one woman all month, have been cool. Some bang their heads against walls, some poop on the floor, some think its funny to charge at staff, and some, to my entertainment, spend their days sliding across the floor in their socks (they aren't allowed to have shoes). But of all the patients, none have taught me more about psych than my schizophrenic friend, we'll call him David.

David is over 50, talks in code languages, walks about 15-20 miles in a day if we let him around the ward, wears glasses with one lens, calls me judge judy, tells me to jump out of the window just about daily, will only wear unmatched socks, and carries around a curious george doll everywhere he goes. He is pleasant most of the time (as long as he has george), very intelligent, and is really harmless...he's just very psychotic. On a daily basis he asks me about my fishing trips, tells me he bought me a white horse, and tried to convince me that barak obama has given him kingship of the country and he can leave the ward...at the very least he's a break from all of the PTSD and depression. He's crazy, but he's happy, and I love that. So now that psych is over i think about what I've learned and he is def somebody I will never forget and he's taught me a lot about mental health in general. It's crazy to think I've learned more from the most psychotic man on the ward than I have from my preceptor. I would thank david for his help, but he'd probably respond in "our" code language that i'm apparently supposed to understand but I don't lol. So I guess I'll just shake his hand and thank him for the horse!

My interview with David today:

Me: David, can you tell me why you refused your valproic acid this morning?

David: "It makes me upset..."

Me: Can you describe how it makes you feel specifically? Headaches, dizzy...?

David: "Let me show you..."(proceeds to rip the head off of curious george doll, while making loud sound effects, stomps on it and throws it against the wall)"....that's pretty much how I feel"

Me: ummmmmm...(trying not to laugh hysterically)...I think I need you to give me curious george now.

Poor curious george.

Day by day...

2009-10-11T23:12:00.002-05:00

It's been a while since I posted something...I've been busy! Psych at the VA isn't too much at the moment actually. It's quite entertaining most days and other days its really eye opening at how devastating psychological problems can be. I can say that i DO NOT want to be a psychiatrist but it is very interesting. I just don't think I have the patience to deal with schizophrenia and depression everyday without developing some component of the disease myself. I've been there 2 weeks and I think I have panic disorder from being around some of the patients. It is a cool rotation and I'm enjoying it quite a bit. Especially when I'm told to jump out the window, stop forging signatures, stop being a spy, and to stop torturing the kids. Yes, I have been told by my one schizophrenic patient to do/not do all of the above things!

If there is one thing that I am learning at the VA, it's how terrible the current war is affecting the young soldiers, and that makes me sad. I don't like talking to guys 3 years older than me about their PTSD from when they watched mass casualties. I guess since I'm going to be part of the military, as a doc, its good to know what my potential patients are dealing with. But its still sad nonetheless.

On a lighter note, SOMA is in 2 weeks!!! AHHHHH!!! Freak out mode began again today when I watched the St. Croix 70.3 on TV....idk why, but i got scared! I was doing so well with my confidence and knowing that ready or not, I was gonna do fine. Plus, I never consider myself "ready" for anything...i usually just do it and decide later. I just really need to make sure I have everything taken care of with my bike and prep plans for the tri. This is a big race and i would hate for something to go wrong that I could've prevented because I'm still somewhat of a beginner. So, this next week is going to be my last hammer week of training, I have to make the most of it! I'm really anxious to do the race (not the pain part) and be done with it. It's been building up in my head for so long now, i'm finally ready to conquer it and focus on the next thing!

Funny note: my cousin and I have agreed to try a 1 month trial on yahoo personals together. Mainly to get funny stories at the ridiculousness of online dating, but also to perhaps make new friends in the area. Watch I'm going to manage to find the strangest/craziest guys....story of my life! lol Anyway, I'm pretty much over going out to clubs and staying out late and playing dress up to meet guys. Most of the time the guys you meet out are less than impressive to say the least. Also it could be cuz i'm a lamo and enjoy going to bed at 10pm on sat nights so i can get up and ride in the gorgeous AZ weather or do something else fun outdoors. That is way more appealing to me than being hung over and sleeping till noon. I swear there has to be guys out there that enjoy that....right???

I'm in no real rush anyway, just going one day at a time and hopefully letting things work themselves out. This is one of my favorite songs that in my head right now, of course its on Grey's, not to be girly cheesy again....

interesting dialogue

2009-09-22T23:40:00.003-05:00

A real dialogue I had today that could be totally misunderstood if not in the context of a radiology reading room :

Dr. K: So i'm just going to look at breasts for the next few hours, that might be boring for you, I usually sit in the back room and do it alone.

Me: Oh ok, should I wait and just come back after lunch?

Dr. K: Yea it could take a while.

Emo Post...

2009-09-14T23:05:00.002-05:00

I feel like this song today...even with the Grey's Anatomy clips.

So as with everything, there are the good days and the not so good days. Today was a not so good day for me. I started radiology today and it wasn't the rotation itself that made the day not so good...just the beast that is the medical world that made things kind of difficult. I was talking to my cousin about this the other day and today it was just confirmed

Sometimes the world seems really out of balance and like there is no reasonable explanation for things. Example,

the patient that does countless harmful things to their own bodies and others but seem to always catch a break. Despite their bad habits

and just flat out being a bad person, they're healthy, able to continue ruining themselves and other with their bad decisions for years to come. . And then there's the

patient that has worked very hard his entire life to make an honest living, provide for his family, and be the best

husband, son, and dad he can be...he get's stage 4 cancer at the age of 42 and only has 3 months to live. I know

life isn't fair and sometimes things just "are". We can't change it or explain it. But in my case, maybe because I'm still

"green" as they say, it gets to me. I sometimes get a little sad when I take a step back and really see what I'm doing in

all of these hospitals I go through. In the same hour, I could be wheeling a single mom, with nobody to say good bye to her

back to the OR for yet another surgery to add to her list of battles against her aggressive breast cancer and trying to

explain to a completely healthy (physically) 28 yr old that we will not give him any more xanax just because his "friend accidentally

threw them away". It often feels like our efforts as medical people are being wasted. In the end, some of the

best people can't be helped, no matter how hard they fight, and some of the worst people, will never truly know what it's like to fight for their life.

Other than some bad news about a family friend and an difficult patient today, nothing happened specifically to

make me feel sad really, just one of those days I guess. And although there are depressing things going on everyday

in the world, not just in the hospital...most of my days are still good! I still love it (maybe cuz I'm still green) and I

try to look at it like anything else in life...all about perspective. Things happen for a reason? Maybe, who knows. But

regardless of who we can or can't help, after a certain point, people die, they get cancer, little kids lives are cut short, its out of our hands. I'm somewhat of a control freak at times

so I don't like the concept of things being that way, but I'm working on accepting it. I do get emotional at times

with work and patients and stupid doctors, but I think recognizing these things is a good thing. If there's one point I

never hope I reach it's to be able to numb out all emotion for the myth of "it's part of the job to get used to it". For some reason

I was thinking that the emotion was the part of the job that made us all want to be in this profession.

Tomorrow's another day!

I feel old...

2009-09-08T18:13:00.003-05:00

My favorite baby...esp when I need to get the chalk off my hands!
I'm not very good at bouldering

So, this weekend past labor day weekend was fun. It was relaxing, I got a lot done, and got to watch the Gators open what I know will be an awesome season. The Chandler Gator club was a good time. It's great how you just feel a certain connection with people simply because they're wearing the same Tebow jersey as you. I literally talked to this couple like they were my best friends for 10 years....I only met them 5 minutes before kick off, it was awesome.

For once (i broke down and didn't want to get crap from my friends for being "antisocial") I went out 2 nights in a row and skipped both of my morning rides, Strada and solo. I sort of get into a routine of not going out and getting up early for a long ride but I forget that its ok to miss a weekend, go out and have fun with friends. I'm glad I have friends that can remind me of this. However, when I do go out, I get tired around 11pm...unless of course I'm really having a good time with plenty of beers lol. I say I feel old though because I do get tired early and I'm usually the "mother" of the group/ DD. That is totally fine with me, just makes me feel like a soccer mom driving my kids around in my big SUV haha.

But I also felt old this weekend after attending a Strada training seminar. I was always the kid that went to school and played sports...that was my life. As we were going through the team's training plan for this season, I realized I was no longer one of the kids that just took the team schedule without a care that it would fit into my schedule. I was getting really excited about the different rides throughout the week until I realized, "oh wait...I'll be on Surgery that month, probably getting no sleep....how am I going to fit in 10 hours/week in the saddle???" Although I've been in med school for 3 years now, it just now hit me that all the triathlon/training things I used to do revolve around my work/school schedule...like a real adult...ahhhh. It sounds stupid for it to just be hitting me now, I've always put my school first. But I have never had a problem working the necessary cycling, running, swimming, whatever, into my schedule. I've never had to tell myself "ok this month, I won't be able to work out, sleep comes first." Then again, I'm also the stupid one who will sleep 4 hours just so i can go on a longer ride/run the next day...and then end up getting injured. SO...i guess my "ahhhhhh" moment was good for me. I know I need to not put so much emphasis on triathlons and how behind i am in training and just accept that I'm doing my best to balance life. (I mean, who and I kidding, am i going to be a pro triathlete or cyclist?? Yea right!!) In my case that includes learning to be a doctor, a social person, a "for fun" triathlete, and all the other billion things I try to squeeze into my life!

In other news...i'm getting really into rock climbing, its so much fun. I've got a sprint tri coming up in 3 weeks (ahh!), and half iron-man in about 2 months (double AHHHH!!). Oh and anesthesia is going well. I go to bed at 10pm, run in the mornings, intubate a few people everyday (or attempt to and fail miserably seems to be the trend), try not to break any teeth, eat the doctors lounge food, and pretend like I know what I'm doing, but we all know that 3rd year med students are generally clueless.

SO...if me feeling old helps me put things in perspective and re-evaluate my priorities, I guess it's a good thing. I'm just afraid of the one day when I actually am old and I'm trying to feel young lol...

p.s. check me out at Strada racing The pics are kinda corny and I have no bio cuz i haven't gotten around to thinking of anything wise...other than..." I LOVE BIKES!"

Anesthesia..day 1

2009-08-31T20:50:00.002-05:00

So I started anesthesia today...and all in all it was pretty cool. I don't think I would ever want to go into anesthesia, but it is an interesting field.

Things I learned:

1. Surgeons really are jerks and think they're God

2. Orthopods are even bigger jerks

3. People do crazy things when they wake up from anesthesia

4. Everything is about perspective

5. WEAR LONG SLEEVES CUZ ITS FREEZING IN THE OR!!!

6. Eat a snack after every surgery

7. Orthotics are NECESSARY!!

I'm' only here for a couple of weeks but it should be exciting to practice my skills. The docs I'm with are really awesome and said I can do as much as I want...that could be scary.

Training is going ...ok. I'm struggling with my heels at the moment. I'm even debating getting x rays to make sure i don't have bone spurs...it hurts that bad. I'm hoping that this will i'll get used to the standing and the pain will ease up a bit. With that said....I'm off to run!

Weekend with Dad!

2009-08-16T22:39:00.002-05:00

The weekend with my dad was pretty awesome! He was looking forward to it sooooooo much and we had a blast! Went hiking in Sedona, Westfork Trail, went on a good ride with Strada, pool, and just hung out together. He LOVED Sedona (of course) and the hike. I hadn't been hiking here yet so it was a first for both of us. We went for about 4 hours through the creeks and mountains, it was pretty awesome. The ride was fun too...for the first time I beat my dad on the bike! Until this weekend...cycling was the one thing he could always show me up with...not anymore! :-) The highlight of his trip though was probably getting his computer. I got my old computer fixed (i bought a new mac) and gave it to him. He has been wanting a computer forever so it was nice to be able to do that for him. It was hilarious trying to teach him how to use the internet though...he still had trouble finding the keys on the keyboard. But now that he has that he'll be more with the times when it comes to technology.

The intense running and transition training starts tomorrow with a 5am run. I've been neglecting the runs a bit so i can improve on my swimming and cycling. It's been going well, swimming is still my nemesis, but overall i'm doing much better. I've really got to make the best of the next 2 months because there's nothing worse than feeling like you could've trained more during a race...worst feeling ever.

2 more weeks left in my FP rotation and I'm still LOVING it. We get a couple new students tomorrow at the office so that should be interesting to see...will they be tools? Statistics say yes...but hopefully they aren't too bad and the type of people who correct the doctor.

Pics from the weekend!

Dogs and babies!

2009-08-11T22:38:00.002-05:00

This is my bff Rohan who I was babysitting on Sunday. We napped together...although the butt up position isn't as comfortable for me. Love that little guy.

My abbers and me being a nerd taking pictures on our walk

Abbey and her new friend Jack Bauer (that's his real name) who we were watching for the weekend while Ricky was out of town

They love to pose

Ali's awesome veggie pizza that she made for her own birthday party

So the past week or so has been exciting. I started with a new doc last monday and i absolutely LOVE him! It's still FP which wasn't my cup of tea...but i have to say i've considered it since i've been with this new doc. Craziest/coolest thing i've done so far: removed a set of hemorrhoids without getting blood on my white coat! I did however manage to squirt enough blood to make the premed student shadowing us almost pass out, that was pretty awesome too, and hilarious. But this doc is truly amazing. He just got back from Mt. kilimanjaro 2 weeks ago. He trekked up with a group of visually impaired people, and for the first time ever with a group that large, made it to the top all together! They set 3 world records and absolutely changed lives on that trip. 50% of unimpaired people fail when they attempt that trek! He does big things...he's pretty much my hero haha. On top of that, he's a phenomenal photographer! In between patients he teaches me a new cool trick on photoshop or how to do cool things with lighting. Have I mentioned that I like him? ok i'll stop.

In other news...training is going well. I established heart rates with Strada this past weekend. LTHR is 168...ok i guess. It was my first time trial and i know I can get that HR down in no time. I need to start kicking the running up a notch...it's been taking the back seat to swimming and cycling. It's also been 200 degrees outside for 22 out of 24 hours in the day, so that sucks. I'm working on it though, no worries.

My dad is coming in to town tomorrow! I'm excited to show him AZ! I'm even more excited to ride with him and the team. He's so excited that he calls me everyday to make sure he's not forgetting anything. Plans are to hike in Sedona, do a lot of riding, and just do what we do...which is usually workout lol. At least i won't get behind. I'll hve pics up of our adventures very soon!

All in all life is good...pretending not to be breakable...

I am Murphey's Law...

2009-07-28T20:00:00.002-05:00

A couple things from today:

I despise:

- chief complaints of low back pain

- when people refuse to let me examine them because I'm a female that "looks like I'm 15"

- grumpy doctors

I love:

- people that are active participants in improving their health

- nice secretaries

- docs that help me learn, rather than already expecting me to know everything (does anyone ever know everything????

Today was going awesome until I decided to practice my surgitron ( mole removing tool, wire loop-esque) skills on a piece of meat. Doc was in a better mood today after I made him stay 20 mins past his quitting time to see a patient (God forbid). Well he was somewhat pleasant until I broke the stupid surgitron! I shoudl've known, I have such bad luck. I was cutting away...and the thing died!! Of course! As if he doens't already hate me, I made him stay late yesterday, and now I broke an expensive piece of his equipment. Granted, its like 600 years old (as is everything in his building), but it just figures I would be the last one to use it when it craps out. I wouldn't expect anything less...such is the story of my life. Even more awesome is that my eval is sitting on his desk waiting to be filled out!! Eek!

By far my favorite pics from the Tour!

2009-07-27T23:42:00.004-05:00

These are some of the BEST pics of the Tour that I've found so far...i love them! It makes me really want to travel to Europe AND get more serious into cycling and photography...all at the same time! I really need to rediscover my camera and take some shots really soon! Pictures of AZ are coming!

I watched the bachelorette finale tonight....and part of me wants to be all bubbly and girly and really believe that stuff like that really happens....and the other part of me wants to throw up all over the place! It's very fabricated love, mostly fake...but I still watch it and hope that some aspect of that "love" they find is real, maybe. Either way, its good entertainment haha. But in all seriousness, i'm not sure if i'm a total believer of the whole "true love" thing, not yet anyway. I'm sure the bachelorette would've been in "love" with someone else had that guy not gone on the show. Maybe that's just me being my usual cynical self...who knows. I guess i think everything happens for a reason, but that doesn't mean we can't alter outcomes ourselves.

Anyway, today i realized the difference between a medical student/new doctor and a seasoned doctor. The new doctor/med student will accept appointments at 4:50 pm (day ending at 5:00pm) and stay later with no complaints. The seasoned doctor (or maybe just my preceptor) yells at the stupid student for taking appointments after 4:00pm and refuses to stay a minute after 5:00pm on the dot! Nonetheless, I took the patient and we were done at 5:25...i was not a popular girl today with the staff. But i don't really care...I hope I never get so desensitized to the point where I turn away patients because they take up 15 more minutes of my time than I had planned. Besides, isn't that the whole reason we signed up for this?

Lazy weekend...boring post

2009-07-26T17:58:00.003-05:00

It's sunday afternoon and I've enjoyed a rather relaxed weekend. I should have been more productive I'm sure, but I really wanted to see what being a "couch potato" really felt like. And I have to admit it makes me feel guilty. I've watched a couple movies, gone to bed early, and just basically mimicked what my abbey does all day. It's nice to relax...but I don't think I could ever be a couch potato. One weekend was good enough for me!

Saw (500) Days of Summer yesterday....loved it!!! It was very creative yet simple and had a great story. There is only one place in Scottsdale that shows independent films so it was really packed.

I got my bike re-fitted yesterday and what a difference! It feels like a new bike! I ended up not putting my aerobars on the bike because my frame is a weird height for them and unless I buy a new handlebar stem, the aerobars will be too high...bummer. Oh well, i can ride just as good without them, I just really like them. Maybe when I have money i can buy a sweet bike! For now, she does just fine for me. Coach and my dad are really trying to talk me into getting into track racing. I think I"d really love it. I actually might give it a shot come october when coach starts the season back up again. My limiting factor will always be time and money, so we'll see!

This next week is my last week at this FP rotation. I'm very excited to get out of there and be with a doc that enjoys teaching students. I have learned some, but it has been a rather frustrating month. It almost feels like I've been on an extended vacation. 1 more week!

Back to my couch potatoing...

"Hey Marvin, can u pass me the brain?"

2009-07-22T16:03:00.002-05:00

Autopsy viewings were pretty cool today. I used to want to be a medical examiner when I was in high school. I love the mystery aspect of the job and how you have to solve the puzzle. But after seeing it today and how it all goes down....yea...I would never want that to be my daily job. At first it was a little shocking to see an empty chest just cracked open with organs sitting in a steel bucket the doc just slicing and dicing the liver, or whatever organ he was on. But after the first body, you kind of get used to it. We saw a couple of decomposing bodies and that just adds a whole other element of ghastliness, with the whole rotting flesh smell. They say you get used to it, but I'm pretty sure i don't want to be in any situations where I "get used to" the smell of rotten flesh and death, not so much, thanks. I guess my days of wanting to be Dana Scully from the x-files were a little far fetched lol. I just thought she was so cool and smart...AND her hair looked awesome during all of her autopsies. Knowing me, i'd get dead people blood all over my face cuz i had an itch in my eye haha. It is very interesting, to say the least, how the docs and forensic techs sort of dissociate themselved from the bodies. They joke and laugh and try to guess how people died or make up "alternative endigs" so to speak. And really, its no disrespect to the dead, they just have to find a way to not get bogged down with the death they see everyday. I can imagine if you don't lighten up, you won't make it very long.

Total today, we saw 2 decomposing bodies that were found in the desert, a suspected drowning, a MVA, and a man found dead in a drop house, suspected overdose. I was actually a little sad, to my own surprise, to see the drowning. It was an old man who looked like he was such a sweet guy. He could've been anybody's grandpa, just went for a swim, but ended up getting tired in the deep end and drowning, really sad. It still is somewhat shocking to see how they just manhandle these bodies around so rough. I guess its the job, but i just kept picturing my grandma or somebody on that table being cut open and eviscerated like that...unfortunately i'm a very visual person lol. I visualize everything, even the bad things. The lighter side of that case was that as they were making the classic "Y" cut...we saw a "cyst" near the bladder. As the bowels and everything were being removed the tech popped the cyst and it ended up being a penis pump! It was actually pretty entertaining cuz we were all trying to figure out how that exactly works. I guess you work with what you have to lighten the mood of this poor old man who drowned. It was an interesting day that's for sure. Glad I got to go and observe!

In other news, i'm sad lance is in 4th in the tour. I really wanted him to get it this year, but its not over. I just really really hope he comes back. I don't like Contador, he's a little jerk. In my own training news...i'm going to start getting really really serious starting friday. No more every other, when i'm not tired, workouts. I HAVE to make myself run outside, swim more often, and ride like there's no tomorrow. I need to take on the heat and just do it. I know if i don't, i'll just look back and say "i should've done more with the time off I had." Not that I don't have time off...i still work all day everyday, just a short day...like 8 hours...instead of 14 or 15 like i'm going to have here in a couple of months. So no excuses, I have to get in gear!

Makes you wonder about doctors....

2009-07-18T19:17:00.002-05:00

So today I had the great opportunity to sit in a required 8-5 meeting of the Arizona board of osteopathic examiners. All I have to say is...wow. The board basically reviews case complaints against physicians by either patients, other physicians, or anybody else for that matter and determines if action should be taken against the physician, i.e put on probation, suspension, writing letter of concern, etc. It's different than appearing for a malpractice case, this is of no monetary gain/loss to anyone, it's just a BAD thing for a doctor to go through. We saw cases ranging from physicians over prescribing opiates (maintaining people's addictions), writing narcotics for themselves, poor charting, and my personal favorite, telling patient her shot is not a steroid, but rather it's actually MAGIC. (I just want to mention that this doctor also wears his best jack sparrow costume in to work, lies on the floor on his belly to read patients charts, and wore a suit with sandals and red socks to his meeting before the board today!) So, although some claims were funny, some were unfounded, most of them were scary...really scary. We're always taught the importance of charting correctly and documenting EVERYTHING but after today...I'm seriously thinking about writing down my patients' outfits at the time of their visit, not really, but almost. It really put in perspective how important being thorough really is. I mean, of course we shouldn't half ass anything when it comes to patients...but it's incredible how much you have to think about as not to miss anything. They always say if you really are attentive and really focusing on the entire patient and the patient's best interest, rather than just thinking about covering yourself...you won't miss anything. But it's almost like you need to find a balance between the two things. But then again, doctors are human, they make mistakes, and unfortunately unhappy patients these days like to find the smallest thing to file a law suit. So it's kind of daunting right now trying to just learn how to think like a doctor and having to keep the thought in the back of your mind that on any given day, with any given patient, if you forget one thing, if you don't write it down, or even fail to mention it...you can be in trouble. And knowing all of that....there are hundreds of doctors out there just doing a crappy job at caring for people, failing to do even the basics, and just plain being jerks to their patients. It made me really think/worry about all these doctors my family and friends go to. How do more people not die?!?! I'm afraid of killing a patient just about on a weekly basis, it's crazy the pressure. But i suppose it comes with the territory. Somebody once told me that if you picture every patient to be your mom, dad, sister, brother, grandmother, etc...and you treat them the way you'd want your family to be treated, you'll be great. I hope so :-)

And just a tip to my family/friends in the non-medical field: write down EVERYTHING that relates to your healthcare, hold your doctor accountable for giving you the BEST care you can find, ask questions...and don't stop until they are answered. Be that annoying patient who asks too many questions, it's a good thing! Doctors aren't immune to mistakes and after all, it's YOUR life, who better than to know everything about it than you! (ok i'm done preaching now)

K i'm off to enjoy my free sat night on the town in scottsdale!

p.s. if your doc ever tells u a drug works by magic...RUN!

Make the most of your life!

2009-07-16T23:32:00.003-05:00

Our very last patient today was one that I don't think I'll ever forget. She was a 29 y/o female diagnosed with Acute Disseminated Encephalomyelitis (ADEM)....a very very rare demyelinating disease. It's pretty devastating and causes progressive loss of muscle function, cognitive function, hearing, bladder function. But despite her condition, she was so happy with her life and just lit up the room with her spirit I was pretty in awe of her. So as I'm doing a annual physical on her we're talking and I was struck by how much her personality reminded me of my cousin casey that passed away years ago from Lupus. She too was very sick...but she was always so happy and bright that you would never know it. Despite my patients condition, she was so smart and inspiring. She was very interested in whether or not I had a boyfriend, which was kind of funny. But she went on to tell me that I was very pretty and that I would meet the love of my life if I was just patient. Another thing that really moved me was how her husband cared for her. Like my cousins husband who was always by her side through all her illnesses, my patients husband seemed to be her angel as well. She walked very slowly with a walker but he carried her to the bathroom and cared for her like she was his most precious possession. Sounds silly, but i really got emotional just seeing them and how it reminded me of casey. So after she left the office I read her entire chart and just couldn't believe what this woman has been through, and still had a smile on her face. She told me that despite her disease, she was determined to walk alone on her 30th birthday...it meant more to her than anything and she was going to do it, no matter what the doctors said. Although its unlikely, I think she can do it. I only met her once, but she seemed like one of the strongest women I've ever met and I'm very happy I met her.

Just seeing her and the struggles she goes through just to stand upright really moved me. I was going to take the day off but she made me really see how lucky I am. I came home, swam, ran, and lifted at the gym. I just know that she would give anything to be able to walk, much less exercise...so that inspires me to get out there and make the most of my abilities and the awesome life I've been blessed with. I and i think we all often forget how lucky we really are. It's good to take a step back and realize that no matter how unfair, difficult, or stressful our lives seem....it can always be worse...and our attitude towards life is extremely powerful. It was a great end to the day and I'm really going to try to smile through even the toughest times and make the most of my life...like my amazing patient and beautiful Casey.

Do what you love...

2009-07-15T20:30:00.002-05:00

So today we got our scores back from the USMLE step 1 (my first set of boards that I took this summer) and I did not do so hot. I was going to put off checking my score report for a couple of days just because I know my track record for taking standardized tests....IT SUCKS. I'm willing to bet that I'm the worst test-taker you've ever met, seriously, I am. I've never known myself to do "well" on any standardized test....even after taking it a couple of times. I used to get very discouraged because I felt like I was dumb and didn't know the material...but after making it to medical school, doing fine in the 1st 2 years of medical school, I think i've proved to myself that i'm not a complete idiot. I JUST CAN'T TAKE STANDARDIZED TESTS!!! It is reallly ridiculous how I can know the material well enough to explain it to other classmates...but still freeze up during the test, or convince myself to change my choice to the wrong answer. Or my favorite, I have a gut feeling of the answer...but of course I pick the choice that i've never heard of for some reason that I will never understand. You'd think that after knowing how terrible of a test taker I am I'd be able to fix it or at least improve it. I thought so too, but after this test score, I don't know what else I can do. I'm pretty convinced that some people are just great test takers, and some just suck at it (like me)...and that its not a useful tool to measure one's knowledge. I appreciate the purpose of the tests but I still think less emphasis should be placed on them. The good thing is that I'm not sure what I got on my COMLEX, the set of boards that matters the most. But if these tests follow the pattern that is my life, I'll retake them (making my life more complicated) and do fine and just keep on going, like I always do. I'm not complaining, but nothing in my life has ever gone as planned really or without hard work. I know everyone says "nothing worth doing is easy"...yea, but seriously, can I not work twice as hard as everyone else for once? please? Can I be like normal students and take tests just one time and do ok....too easy, i love to make my life difficult.

So I was pretty upset earlier today and had a hypertensive episode and near anxiety attack (good thing i was in a docs office) that lasted like 10 mins. But then I got a call from a patient that called specifically for me. I'm thinking, "why do they want to talk to me, the student, and not the doctor...weird." I had seen her earlier in the morning for persistent diarrhea related to celiac dx and lab follow up. She was actually an awesome patient because she took such awesome notes and asked all the right questions, really making us (me and doc) explain everything about her dx that she didn't understand. I really like it when patients hold their doctors accountable and basically make us do our job. Not to mention, she's very well informed about all of her health conditions. Anyway, I spent almost 30 mins (i can do this b/c we see very few pts at our clinic) explaining her labs to her and what everything meant. So she was calling me to thank me and pretty much tell me that she really appreciated me taking time to explain things on her level, not being annoyed with her list of questions, and that I was going to be a great doctor. She also told me she didn't quite like the doc (he couldn't answer some of her questions and found her annoying) because he somewhat blew off her questions.

So after stupidly looking at my exam score at work and getting upset....her call really put things into perspective for me...I must be doing something right. (hopefully) I can answer every question a patient has about labs and her 5 different diseases...but I can't do well on my boards, i don't get it. So I'm over being mad about my exam because despite how tough and frustrating things get, whether its stupid exams, crazy patients, ridiculous hours, inconsiderate people...the awesome patients and gratification that I am actually helping people makes it all worthwhile. I know there will always be something to get frustrated/upset about...but as long as we don't lose sight of why we do things in the first place, we won't go wrong. And today, my sweet patient reminded me of why I take tests over and over until I pass, why I sacrifice so much time for studying and, why I've put so many things on hold while in school....medicine and helping people is what I love. I'm so grateful that she reminded me of that today, it was exactly what I needed.

So I'm just waiting on my next set of scores, hoping for the best, but somewhat mentally preparing for the worst. I'm doing better at learning to accept things I can't change and move forward. It's kind of cheesy but it really is true that no matter how hard things seem, doing what you love and loving what you do really is a great philosophy.

p.s. i can't wait for lance to win the tour!

It's been a while!!!!!!

2009-07-12T23:26:00.002-05:00

So, It's been over a month since my last post...crazy! I have been crazy the past few weeks. I took boards (hopefully passed), got completely settled into the Arizona life, and I've started my first rotation as a third year medical student!

I LOVE it here! It is HOT, today it got up to 116, but i'm not complaining. I am meeting tons of people, getting some awesome riding in with Team Strada, swimming like crazy and really getting in to the best shape of my life. I'm finally acclimating to the dry heat and my lungs don't feel like they're going to explode anymore after 3 miles.

I'm working in a Family practice clinic this month in Mesa. It's been somewhat interesting this first week for several reasons. My doc is one of those docs that is very old school (he's like 75) and isn't really keen on change. He's a good doctor, but he's also doing things the same way they were done 30 years ago when he started practicing. So, I've been struggling to find my grove with him and really get a great experience out of it. The awesome thing is that 80% of the people we see are spanish speaking only. Awesome because I get to practice my spanish a lot, which is a big reason I came out here. But aside from the spanish, i'm working with my admin to possibly get switched. I'm really not getting the experience I should be getting as a 3rd year student in this clinic. So I'm trying to learn as much as I can without getting frustrated. After all, I'm with another guy at another clinic in 3 weeks.

Although I'm not really practicing my physical doctor skills really yet, I have learned a lot about people. When I say people, I'm talking about the low income population of patients that we see. Most of the people are at least well informed about their health and are actively trying to remain healthy or get healthier. But a small percentage just don't care. Most of the time, they only come see us because they hurt and want meds. No matter how many times you tell them that a pill won't fix the pain, the only thing that will make them better is a complete life style change, they don't listen. They don't want to listen. I was surprised by the number of patients that don't listen to anything we say, they just want to walk out of the office with some form of prescription, for anything because they think it will fix their problem. Of course not all are that way, but a larger number than I was expecting. I've had to tell patients that they might as well save themselves the copay if they're not willing to listen and try to understand what the docs are really saying to them. Of course I'm compassionate and try to see their side and realize how difficult it is...but some patients admit they just want pills. Not even narcotics, its a psychological thing. They feel they will actually get better with a pill, even if we both know it won't help them much. I'm quickly learning that people think differently when they get "sick". Maybe its the way the healthcare system works in this country and the expectations put on doctors and medicine. But it is something I don't think we'll ever understand. People are funny, weird, mean, awesome, rude, and then some. Sometimes you just have to laugh to stop yourself from going crazy trying to keep up with all of them.

But I'm def enjoying life right now and working out a ton to balance out the crazies at work :-)

Studying, working out, and not being awkward!

2009-06-09T21:21:00.002-05:00

So I've been sticking to my schedule of working out and studying pretty strictly for the past couple of weeks now. Studying is going well, but I just feel like there's no way I'm ever going to know everything. I wonder if anybody actually gets to the point where they feel ready...I'm not counting on it. I take the test in a little over a week and it feels like even if I had another month, i'd still feel not as prepared as I should be. I just have to get a much in as I can and pray that during the test i'll be able to find the answers...cuz i know there in my head somewhere, it just takes me a while to find them. I have really enjoyed being able to sleep in (until 8am lol) and wake up on my own schedule with no requirements to be anywhere...except for the pool! Some days I just stay at home and study but others i need to get out. I will say this, I never really doubted it, but I've confirmed for myself that I could never work from home...or be a stay at home mom for that matter. Being at home all day makes me lazier than ever. Even if i'm studying, it sucks, i need to be out studying somewhere or doing things. It's nice every now and then to relax at home, but I think i would drive myself crazy. I sometimes complain that i overload my plate with responsibilities and goals and say "there's never enough time to get it all done!" But when I think about it and now that I do have the time...I still don't get it done! So, i'd much rather be running around crazy and accomplish the 8 out of 10 things on my list for the day, than take my time and still only accopmlish 5 things. But that's just me, I sick and enjoy stress. :)

In other news, I have my free personal training session (came free with gym membership) this week. I know i'm pretty out of shape at the moment, but maybe if they can quantify my out of shapeness...i'll just be that much more motivated! I just hope they don't pinch my fat with that pinchy thing for body fat...i have always HATED that thing since middle school and i swear they always pinch way more than they should!!! (well that's my excuse) I'm going on my first ride with Strada Racing Club this Saturday, I'm pretty excited/nervous. I've never ridden with a big group before and knowing me, it could be disastrous. Maybe I should warn the head coach of my klumsiness and gift of ensuring that everything that can go wrong, does. Speaking of my murphy's law gift...i had a sasha moment last weekend! It was actually kind of funny. Went for a ride, 8 miles in got a flat....fixed the flat (took me forever)...realized my pump didn't work....still had a flat...realized i know nobody in tempe that could pick me up (crap!)...asked a cop for a ride home...he said no cuz he had to go get a drug bust...was stranded for an hour and a half before i realzied i had 1 friend in town....i was rescued!!! My early morning workout-so i can study plan only got me a 8 mile ride and sweet bike short tan lines...gotta love it.

Anyway, my week is full of more studying and more working out...oh and figuring how to make small talk. FYI med students (or maybe just me, but i'm sure i can generalize here) are the most awkward people to talk to...unless you talking about squamos cell cancer of the lung or a big test coming up. I have met about 4 guys in the past couple of days around my apartment or at starbucks that have been nice and potential friends (my friend count here is low).....but of course, me being a huge spaz, an incapable of making small talk for some reason. I'm a weirdo and i freeze with this look on my face like i'm in shock that a guy is talking to me lol. Or maybe its just that they catch me at bad times??? (doubtful) Either way, i need to practice on being a normal person again, able to have normal conversations with normal people...not about medicine! That's my plan for the week. I'll let you know how it goes!

Getting back in gear...

2009-06-05T11:25:00.002-05:00

This week has confirmed for me, because it hadn't hit me yet, that I am finished with class! YAY! My schedule for the past week has been study at home 8-12, lunch, study at starbucks 1-6, workout, walk abbey, sleep....and repeat. To you this probably seems like the worst week ever, but I'm actually loving it!! Granted, I woudn't be studying if i didn't have to, but i'm sort of enjoying studying on my own schedule for once, no classes to work around or stupid labs to attend. And even more surprisingly is that I'm more focused here in Tempe, with a million distractions around me, than I was in Kirksville, the land of nothing to do. I guess I just know that at 6pm i'm free to distract myself with the gym, the pool, or my bike, well not so much the bike anymore because I busted the air valved on it last night getting ready for a ride! grrrr. I was all geared up to go too...man! I guess its not a huge deal, I just need to get it fixed asap so i can get back to riding!

So after rendering my bike unridable i decided to run to my new gym and swim a bit! I just joined Lifetime Fitness here, its not far from my apt at all. I LOVE IT!! The pools are great (a little cold but i'm always cold) and its soooooo nice, and actually not very expensive. I'm really excited about it...I just have to get familiar with everything so I don't look like that girl who's never been to a gym before! (i was her yesterday)

It's only been about a week but I already feel better in my workouts. Slowly but surely i will win this battle with the arizona dry air! It's not so fun when you feel like your lungs are full of dust and you have the worst cottonmouth ever! But its ok, i'm getting better. I found some awesome bike shops in town that I need to visit this weekend, i love bike shops...its like my candy store. I've also emailed a couple triathlon clubs here about joining. I want to start getting more serious about training and actually train with a group again. The Phoenix triathlon club is pretty serious and it seems awesome, but i'm not sure how far i'd have to drive since I live in Tempe :-( But i'm about 80% sure I'm going to join. If not that club, I'm looking at Strada racing club. That's through the bike shop and its more of a cycling team but they do have a small triathlon team. I have to look more into them this weekend. Ok well time to study!!! For some reason Friday's don't have any real significance...maybe since i have no real requirements during the week anyway lol. Maybe i'll treat myself to some tv tonight with my girl abbey :-) I'm such a rebel......

Fresh start...

2009-06-02T01:28:00.003-05:00

So it has finally hit me now that my family left that I'm actually living in Arizona! I had such a great time seeing Sedona and the Grand canyon with them, i'm so happy they were able to make the trip. It very rare that I get to do things like that with my aunt and uncle, they had a blast!

I love the "new" feel of my apartment. Everything is so new and unused and clean! (thanks to my aunt) I love fresh starts, and AZ is exactly the kind of fresh start i was waiting for. Today I started my real hard core board studying and workouts. The studying went well although i was interrupted by the fact that my internet was down and it was driving me crazy. The run was not so good. I really need to get used to this dry air...nosebleeds while running aren't fun. Not to mention i was running like I hadn't ran in a month...oh wait, I haevn't!! Eeeek! The good thing is that runs like tonight make me want to kick my own butt back into gear, it was just pathetic. I'm still debating whether or not to race in the sprint tri in Flagstaff on the 9th. I really don't have the money :-( I'm going to keep thinking about it, but my bank account is scaring me right now since I just moved across the country!

But regardless of that tri, i'm going to get on a strict workout, perhaps 2 a day, schedule. I need to sign up at a gym ASAP so i can swim!! So basically my life for the next month will be board studying + training...yay!

Abbey is loving the apartment. We are right by the tennis courts and she watches people play all day. I'm sure she's laughing at how terrible they are in her head. I think I'm going to start a blog for her. My cousin came up with the idea, and it'll give me another thing to take up my time, awesome. She's great though, she deserves her own blog!

I really just am so happy to finally be in AZ. I feel like I'm exactly where I'm supposed to be right now. Many great things to come!

I made it!!!

2009-05-28T12:32:00.004-05:00

So I'm finally In Arizona!! Above are a couple of pics from the drive...I'll post more soon!!! We've been here since Tuesday evening actually, I just haven't had access to internet and have been crazy (in a good way) unpacking and getting settled. The drive was fine. My mom and I were in my X-terra while my uncle and aunt were in the moving truck. We made it here faster than expected, which is awesome...more time to hang out with the family in AZ! (not to mention being stuck in that car/truck and staying at hotels where I had to sneak Abbey in wasn't too fun) We've spent the past couple of days unpacking all my boxes and setting up my apartment. It's an awesome thing that both my aunt and my mom insist on helping me clean, set up, cook, and buy things for me...i'm super grateful to have them!! It is kind of funny though when they fight over how they disagree on how MY apartment should be set up and where I should put things. They are both over 50 but still fight like they're 5. I just sit back and laugh at them with my uncle! Even more awesome was when my mom bought some "beer" (smirnoff ice) for her and my aunt to relax... 5 minutes and 1 drink later they're drunk trying to organize my kitchen...all this while fighting with eachother on where my coffee pot should go!! I really love my apartment though...and so does Abbey! (this is very important because she pretty much rules it anyway haha) The best part so far...there are bike paths everywhere!!!! I'm itching to get out and really ride but I'm going to enjoy the family company and do whatever they want while they're here. Not to mention my board studying has been kind of sporadic the past few days. That's ok though, I purposely planned boards later for this reason. It's not very often that I get this time with them. Starting Monday though...it's on! Sprint Tri in Flagstaff on July 9th is getting close!!! Ahhhhhh!

This weekend we're heading up to Sedona to take a couple tours of the Red Rocks and The Grand Canyon, it should be awesome! I'll most definitely have pictures after the weekend and will keep you updated once I get my own internet.

p.s. high of 101 today = i'm in heaven!!! I love this heat!!!