Housing and Hematology

It has been a stressful couple of weeks. We are in the middle of Internal Medicine, which is going great. We thought we might be able to stay here in Miami and complete our third year of medical school rather than moving to New York City, but it looks like the clerkship agreements won't be signed in time for us to stay (the pediatric and surgery clerkships for third year students will probably be in place sometime next year). Anyway, now we are trying to find housing in New York. Now, finding housing isn't too horrible (it is a big city), but I have never been to New York so it adds this mystery, which makes everything more difficult. But heck, if I can live in Dominica, I can live just about anywhere. Besides, as far as I know, there are no herds of cows running free and controlling New York City.

Since I have been stressed, I have decided to study one of my favorite things in medicine this week: Hematology! I know this sounds nerdy, but I think the clotting cascade is just beautiful. I haven't looked at it in a while and I almost forgot how breathtaking it is! There are multiple checks and balances to ensure that we don't clot too much, which can kill us, yet we are able to clot quickly and efficiently. We also break down clots in a timely fashion. We are constantly clotting and degrading clots. When things go wrong with the clotting cascade, everything goes to heck in a hand basket, for example Disseminated Intravascular Clotting (DIC). Since I get so excited about clotting, maybe I am destined for hematology and oncology.

Isn't it beautiful?

Competent

I am about a year and a half away from earning my Doctorate of Medicine.  The end is almost within sight!  A year and a half is a reasonable amount of time--it isn't the far distant future anymore.  That is exciting on one hand and down right scary on the other.  In a year and a half, I will be one of the people who (should) stand up when someone desperately asks for a doctor on a plane or in a busy restaurant.  I will be responsible for others' lives.  I will be a doctor.  Granted, I won't be on my own for at least another 3-5 years of residency training and if I specialize, I will have another 3 or more years of fellowship training before I am solely responsible.  Nonetheless, I wonder almost daily if I am learning enough, if I am working hard enough, if I am competent enough to be a physician.  Am I smart enough?  I think so.  According to my board scores, I am.  For some strange reason that doesn't bring me much condolence now that I am trying to master the clinical sciences.  I feel like I am having a much easier/enjoyable time learning the clinical sciences (medical school years 3 & 4) than I did with the basic sciences (medical school years 1 &2), but am I learning enough?  From talking to residents and attending physicians, everyone goes through these feelings and most people have told me it will get even worse during the intern year (first year of residency).  But as my dear friend Mary told me, "If medical school was easy, everyone would do it."

I should get back to the books...

Three Day Weekend!

I have a three day weekend because the doctor that I am assigned to this week is returning from vacation tomorrow.  It is another beautiful day down here on South Beach, but am I on the beach reading a novel, playing beach volleyball at Lummus Park, jogging on the boardwalk or enjoying a tropical drink while looking at the Atlantic Ocean: NO.  I am inside studying.  I am reading on the Cardiovascular system, I know, you are jealous.  Once I finish that,  I am reviewing an article on carbon monoxide poisoning that a friend wrote (actually, I am excited and proud about that because she will likely get published--yupee!).  After that, I am going to review my notes on a an article that I read over the weekend, which are discussing in class tomorrow on GERD (Gastroesophageal Reflux Disease, aka, acid reflex).  Maybe, if there is still time left in the day, I will have time to write up a few histories and physicals onto "official H&P" forms from the doctors that I worked with last week.  If I am really lucky, I will get to work out at some point today so I don't become a tubby medical student....

Although this is not an atypical "day off", this would never make the cut for a Grey's Anatomy, House or even Scrubs episode.  I know, you are all wishing you were in Miami Beach studying medicine too.

Dancing and Computers

We were suppose to get together with some friends on Saturday night, but one of them called to see if we could move our get together to Friday night.  I slept horribly last week, so I wasn't too thrilled about going out Friday rather than Saturday, but I pulled myself together and got ready.  I knew I would have a great time once we were out, but I was just tired. 

We ended up going to Brix 46, which is a little neighborhood lounge in the Mary Brickelle Villiage in  Miami's financial district.  It was so much fun!  Farley and I went out with our friend, the PA student from OB/GYN last week, and we wanted to go out with her and her fience.  We also wanted to set up one of our fellow medical students, who also knew the PA from OB/GYN.  It just happened that the PA's friend was in town and wanted to go out so it worked out perfectly.  The music at the lounge was a mix of Latin and Hip Hop.  It was super fun, despite my inability to dance.  I was the DD for the night, which may have made my dancing even worse! Overall the night was a blast.  We were out until 3:00am!  I don't know about you, but that is extremely late for me.  I haven't been out that late since my OB/GYN rotation, and I don't think that really counts.  It was 4:00am before I got to bed and I slept most of Saturday away.  I didn't mean to, but after not sleeping well all week and staying up so late I ended up sleeping much more than I thought that I would.

I did manage to get some studying done Saturday night, so I was happy.  I headed to bed and then got up for Mass Sunday morning.  Farley's computer has been giving him fits and it finally bit the dust late Saturday night, so after Mass, we headed to Best Buy to find him a new one.  It wasn't on the plan for the weekend, but I am so glad that he was able to find something that works for him (and it was on sale).  While we were there, I had my a "tune up" done to my computer and I think it is working faster now. 

Luckily, we have a study day for tomorrow, which is great because I didn't get much studying done today.  I cannot believe that I only have five weeks left in Miami before moving to New York City.  It is hard to believe that the time has flied by so quickly!!! 

Things all patients can learn from two of my patients...

I saw a young male patient, who spoke both Spanish and English, and since he seemed uncomfortable with me in the room and I offered to leave.  The physician that I was working with said, "She doesn't speak Spanish."  Thus, the patient decided that I could stay in the room and they would discuss his problem in Spanish.  To be honest with you, I really didn't care if I stayed or didn't stay because I already had this guy's problem narrowed down to two or three different things just based upon those two sentences...Now, if you decided to keep the medical student in the room and speak in Spanish, I suggest that you do not spend the entire time pointing toward your nether region.  Also, I suggest not pointing to your nether region then taking your hand from a vertical position and flopping it down at the wrist.  These signs transcend all languages and I knew exactly what was going on with this Young Buck.

Another equally animated patient provides some other advice.  Don't check out the medical student in the room and then ask her if she has a boyfriend after learning that you don't have HIV or any sexually transmitted infections (STI). Generally, knowing the HIV and STI status about a potential significant other is wonderful but I am part of your health care team and I can't date you even if you are the Prince of England after being apart of your health care team.  It just makes things really awkward for me, so please don't do it.  However, I think that it was fun when he gave the doctor, nurse and me hi-fives when he learned he didn't have HIV or an STI, so you can do that at your next doctor's appointment.

ICU, I love you!

I have been in the ICU the last few weeks.  I have really enjoyed my time in the ICU.  The patients are the sickest of the sick, which can be depressing at times, but that also means that we (by we, I mean actual doctors) can save lives of incredibly sick people who otherwise wouldn't survive.  It is exciting and as a medical student, it is overwhelming at times because I do not have the skills to manage cases with multiple co-mobilities and I am trying to learn as much as possible from these awesome physicians who do.

We have seen some very, very sick patients.  I saw a person with a tandemheart, which is a cardiac assist device that pumps the blood for the heart.  It isn't the same thing as an LVAD (Left Ventricular Assist Device--as seen on Grey's Anatomy).  Basically they do the same thing, but there are some differences, such as the tandemheart is attached to the patient's leg (yes, I said the leg) and the tandemheart is a short term solution (few days) whereas the patient can live with an LVAD for months (outside of the hospital setting sometimes) while waiting for a heart transplant.  We also saw a patient with anasarca, which is edema all over one's body.  It is one of those things, I read about in medical books and immediately upon seeing the patient knew exactly what it was.  But to be fair, it would be difficult to miss.

There have been a few deaths since we have started in the ICU.  I just hope that as a medical student, that my excitement for medicine has not been interpreted by patient's families as lacking compassion.  There was a woman this week in tears every time the doctor walked into the room.  I just wanted to go give her a hug and tell her everything is going to be alright, but I know that, for her, everything is not going to be alright (and she only speaks Spanish, so I can't even talk to her all I could do was to offer her a pat on the shoulder and a Kleenex).  Someone she loves is dying and at this point, all that is left is to keep that person comfortable.  I think her world is crashing down and there is nothing I can do to help her.

Despite the depressing aspects of the ICU when I left, I felt so alive.  I was more grateful for my health and opportunities I have been afforded, I was excited for the patients who got better and I was relieved that I was comfort some of the patients and family members.

7th Semester

Watch out world, as of today, I am a seventh semester medical student!  When I finish the end of the tenth semester, I am a doctor.  The finish line is almost within sight!

The Obdurate Opponent

I spoke with a good friend of mine from this island this weekend, who we will call D.C. An acquaintance of mine from the island, who is D.C.'s close friend., was recently diagnosed with stage three B-cell lymphoma. This acquaintance is a semester behind me in medical school and was getting ready to take her boards when she noticed an enlarged lymph node in her groin region. She went to the doctor and they worked her up, thinking it would be an infection or something relatively benign as she had felt fine; but, it was cancer that had spread all over her body. I suppose it could be worse, she could have stage four rather than stage three B-cell lymphoma, but this is really bad. She did her first round of chemotherapy and luckily coped well with the therapy, but it is too early to know if she is responding to therapy. I hope that she continues to do well and I hope that she successfully beats this cancer.

One of my colleague during my OB/GYN rotation just restarted medical school. He had been diagnosed with Philadelphia positive T-cell acute lymphoblastic leukemia after taking his first set of boards (that is a horrible diagnosis). He was told he needed a bone marrow transplant and that even with the transplant he was most likely going to die; however, he beat the odds and survived. It has been several years since he was first diagnosed. He is finally healthy enough to be back in medical school and doing great.

Both my colleague and acquaintance were in their late 20s, had just finished their second year of medical school and were given a diagnosis of cancer. I cannot imagine what their experiences are like. It makes me feel so lucky that when I had my surgery in January (when I too was in my late 20s and had finished my second year of medical school), there was nothing seriously wrong. I am so fortunate and I hope that my acquaintance will be fortunate and survive her cancer. I have a feeling in the pit of my stomach that she will be okay and I hope that I am right. I don't know her well enough to call, but I will keep her in my thoughts and prayers.

As strange as it might sound, hearing about my acquaintance and colleague made me remember why I love oncology so much. Cancer is a relentless opponent, but we (the medical profession) can fight it and we can win. I am proud of the pediatric oncology research that I help with. My input may be have been small, but I have already helped fight cancer. At this point and time, I wouldn't be surprised if I ended up in oncology or in obstetrics because I love them both. If I choose oncology, I will get to spend my life fighting with and for those in the most dire need--those with the obdurate opponent known as cancer.