medical school

so…why a year off?

I’ve been asked this question a lot about why I chose to take a year off, so  you can now read my answer in writing 🙂  Particularly for current medical students who are considering taking a year off in the future, check out the blog entry I wrote for Kaplan’s medical blog on the topic here!

PS: Would love to hear your thoughts and opinions…here is my shameless plug for some love in their comments section 🙂 But in all seriousness, the rest of their blog is a nice mix of med students from all ages writing about everything in med school, from first year exams to step 1 to rotations, so lower years, take it as you will!

the other side of the coat

“23 yo F, no PMH, victim of high velocity MVC. Was driving on I-95 from Bethesda to Philly when got cut off, lost control of car and swerved into median. Air bags deployed. Sole victim. No LOC; pain scale 9/10. On physical exam, vitals WNL, AAO x3, Full thickness laceration from the upper lip to the nose and a laceration on the R eye between the cornea and sclera; vitreal hemorrhage visible. Extensive hyphema on R; fundus unable to assess. Vision in L eye is 20/20; R eye is hand motion. CT scan shows bilateral nasal fracture. No lens visible in the R eye. No other cervical, spinal, rib or extremity fractures. “

*abbrev: F = female. PMH = past medical history. MVC = motor vehicle collision. LOC = loss of consciousness. WNL = within normal limits. AAO x3 = awake, alert and oriented to person, place and time.

Last summer, I was on trauma call at Christiana Hospital, mind racing through mental checklists as the nurse in charge shouted “MVC, middle-aged male, arriving in Trauma Bay 3.” The doors flew open, it was ABCs, Glasgow coma scale, primary, secondary and tertiary surveys; the paramedics telling history on one end, the police interrogating on the other end, residents and attendings throwing orders overhead. I barely had time to LOOK at the patient when, in a matter of minutes, he was whisked off to CT, admitted to the surgical service, prepped for OR.  I remember being struck by the cacophony of firm, direct voices and the rapid pace at which things were accomplished with machine-like efficiency. Strict adherence to protocol was vital to ensure the chance of recovery was maximized, but at the time, I couldn’t help but imagine the chaos our patient must have felt, going through so many sets of hands, instruments, rooms, and procedures in a half-conscious fog, covered in blood, stripped of clothes and possessions and left only with a tossed-on hospital gown and blanket.

Little did I know, I didn’t have to imagine for long. Just over a year later, I found myself reliving my entire surgical rotation from the other side of the stethoscope. It was very lucky that I rotated in ophthalmology and anesthesia as a 3rd year, because it certainly helped me somewhat keep track of what was going on, regardless of whether or not I was informed (which sadly, was more often not the case). I am also thankful to have been taught during my rotations that:

1) doctors don’t have a lot of time, simply because they have so many responsibilities
2) we as medical professionals tend to forget to tell patients things, for the same reasons as in #1 and
3) patients know their bodies the best, but not speaking up means we (med people) can’t use it in our assessment and plan.

My background was both a blessing (enabling me to stay adequately informed and ensure recovery was maximized) and a curse (plaguing me with questions to EVERYTHING). I am thankful to my physicians for being patient and accommodating to my borderline-OCD and constant questioning. heh ^__^’

They say sometimes life throws you lemons, and I had always understood the importance of optimism when those lemons come, but I really do believe that if an accident were to happen at anytime, this was the best possible accident. I am so thankful that I was doing research this year, and not applying for residency or stressing at an away rotation during this time. I am thankful that my accident happened about 15 minutes away from Hopkins, quite possibly the best hands by which to have been received.  I am thankful that no one else was hurt in the collision, and that though I was alone, my phone still worked. I am thankful that my L eye was completely spared, and I was able to dial 911. I am thankful that beyond facial trauma, the rest of me is fine.

I am thankful that my eye repair surgery went well, without complications. I am thankful that the recovery from nasal surgery was also relatively uncomplicated, and though it was 10x more painful, I had medication. I am thankful that resources were not an issue; also that I was not unknowingly allergic to any medications. I am thankful the prognosis looks promising in my R eye.

I am thankful that two weeks into my medical leave,  the government shut down, so my fear of missing work or lectures was literally eliminated. (confession of my borderline-unhealthy restlessness/fear of being unproductive ^__^’)

Most of all, I am thankful for PEOPLE–for a ridiculously amazing and patient family to take care of me, tolerate me, and relay the message of what happened to others for me. My mom and dad were true heroes for driving me 3 hours back and forth between multiple appointments, and my brother a hero for flying in and helping me restore my phone and everything tech related. I am so thankful for awesome friends, you guys, who have been absolutely incredible with your barrage of texts, facebook posts, voice messages, emails, phone calls, food, flowers, cards, prayers, and visits…you guys who continue checking in, sending words/prayers of encouragement. I was blown away. I still am blown away. An eternity wouldn’t be enough to thank you guys, and special shoutout to those who have been there from the start (you know who you are 🙂 <3) . I seriously wouldn’t be where I am mentally without all your support. Love you all!!

Finally, I am thankful for having this accident occur at a time in my own Christian walk where I can actually confidently say that I have joy in Him, regardless of the circumstance–that I truly have had a peace that passes understanding. I am so thankful that my faith rests completely in a God who is sovereign, has an ultimate will and plan, and never fails to provide–as evidenced above. I am thankful that because of Christ, I can never be NOT thankful. God has been so good during this healing process, and it wouldn’t have been possible without all your prayers!

I decided to share these details about my journey not in want of pity or sympathy, but rather, to share the importance of being thankful in the little things. They say it isn’t until you lose something that you realize its true value; I would also add that it also helps you realize the true value in the things that still exist around you. I would admit I did have some low points during the course of the month, but what kept me going was this quote, that

The true key to happiness is gratitude

It doesn’t take an accident to remind ourselves of things to be thankful for, however small, and I certainly hope no accidents happen. But we cannot predict the future, and regardless of whatever may come, being thankful can make situations more bearable.  This experience has taught me that more than anything that people are the best reminders of encouragement and thankfulness. No matter what, love people, and keep them close : )

As for me, the good news is that I am finally well enough to (almost) fully function normally! Now I just need to wait for my body to heal over time. There is at least one more surgery I will have to undergo, but that won’t be for another couple of months. I am excited to say I return to work tomorrow.

Life, I’m back 🙂

a life we’ve chosen

…and you BET I’m honored to be in it. Medicine definitely has it’s dark and humbling side, as exposed by this article: To-being-doctors-to-be by Mrigank. However, as physicians, we have the incredible honor of seeing what our bodies can…and can’t do…face to face. Mrigank’s entry was too beautiful and so eloquently written, I had to repost.

Quote:

We who began our adult lives spending alternate days with corpses… Who spend the prime of our youth in the grime of wards. Who have already witnessed a lifetime’s share of deaths. Who learn about depression but fail to recognise it in ourselves…We who are hunted and haunted by questions that have no answers. Who feel guilty when we know less than we should. Who fear that we will never be good enough…
We who cannot ever abandon logic. Who are rational but must allow for prejudices. Who have no choice but to listen…
We who will never tell you any of this.
We who really need to step back and appreciate ourselves.”


DONE WITH 3RD YEAR!!!!

It goes without saying that this year has been insane, from ridic hours to ridic cases, but the ability to experience the nitty gritty of medicine made this year my favorite year yet. Even more awesome was having the honor of working with amazing classmates, incredible residents, brilliant attendings and finally, merciful patients (haha)! The lessons learned this year were unmatchable.

Will definitely miss clinical medicine for a year, but in the meantime, time to get ready for the NIH ;D

(more to come later…now to pack!)

white blood cell (aka white chocolate cranberry) cookies!

eosinophil (leftmost cookie on the L image), lots of neutrophils and band cells (those were easy!) and an attempted malignant lymphocyte (the frontmost cookie on the R…it was hard making the cranberries look confluent together! oh well haha)

On my last day of my heme/onc rotation, I decided to bake some cookies for my team. I wanted to make it creatively medicine-related, but my rotation was on the liquid tumor service and it’s not really that easy to make a visual representation of leukemia or lymphoma…at least in an appetizing way. Luckily, heme malignancies are all about the white blood cells–perfect for cookies! Train of thought: Cells are round; COOKIES are round too! Cells have organelles, cookies have…stuff too! Totally makes sense…lets make white blood cell cookies!!

Cranberries make the perfect nuclei-like shapes, so I decided to use cranberries and white chocolate chips for my ‘stuff’ 🙂 I used this as my template for the cells:

white blood cell types!

And after a search online for white chocolate cranberry cookies, I settled on this recipe from Sally’s Baking Addiction (reproduced below…btw check out her blog for more amazing recipes! :)). This was my first time using cornstarch in cookies and as Sally testifies…it works WONDERS!! Makes the cookies super chewy and delicious… Totally adding this to all my other cookie endeavors in the future!

Needless to say, I (and my heme/onc) team were quite pleased with the results 🙂

——————————————————————————————————-

Recipe: Soft-Baked White Chocolate Chip Cranberry Cookies from Sally’s Baking Addiction
Makes 2.5 dozen cookies.

Ingredients

• 3/4 cup (1.5 sticks) unsalted butter, softened to room temperature
• 3/4 cup dark brown sugar
• 1/4 cup granulated sugar
• 1 large egg, at room temperature
• 2 teaspoons vanilla extract
• 2 cups all-purpose flour
• 2 teaspoons cornstarch <–secret to amazing cookie chewiness!!!
• 1 teaspoon baking soda
• 1/2 teaspoon salt
• 3/4 cup white chocolate chips
• 3/4 cup dried cranberries

Instructions

1. Line an ungreased cookie sheet with parchment paper or silicone baking mat. Set aside.
2. In a large bowl, cream the butter and sugars together until fluffy and light in color. Mix in egg and vanilla. Scrape down the sides as needed.
3. Mix in flour, cornstarch, baking soda and salt. Stir in white chocolate chips & dried cranberries.
Optional: Chill dough (covered) for 30 minutes or up to 3 days.
4. Preheat oven to 350F. Drop balls of dough (1.5 tablespoons each) onto cookie sheet. Bake for approximately 9 minutes, until barely golden brown around the edges. Do NOT cook them longer than 9 minutes. Remove and let cool for 5-10 minutes on the cookie sheet. Transfer to cooling rack.
5. Enjoy! Baked cookies freeze well – up to three months. Unbaked cookie dough balls freeze well – up to three months.

a typical day in the ER…

50-soomeyr old male comes into ED complaining of extreme left lower extremity pain, shooting from his left lower back to his left foot, going on for the past 3 weeks. The pain is described as ’10/10′, throbbing in nature, persists through walking and at rest and ‘is unbearable’–it keeps the patient from sleeping and has made him depressed. No appreciable weakness or numbness in any extremities. The patient has tried taking oxycodone 30mg every 4 hours, with minimal benefit. Of note, the patient tried cocaine yesterday in hopes of alleviating the pain–that also did not help.

 

chemo

On the treatment of diffuse large cell lymphoma:
“Other regimens are now considered only for patients whose condition relapses and who are not candidates for high-dose chemotherapy (HDC) and autologous stem cell transplantation (ASCT) for diffuse large cell lymphoma. They include the following:

  • ICE – Ifosfamide, carboplatin, etoposide
  • ProMACE-MOPP – Prednisone, methotrexate, leucovorin calcium, doxorubicin, cyclophosphamide, etoposide, mechlorethamine, vincristine, procarbazine, prednisone
  • MACOP-B – Methotrexate, doxorubicin, cyclophosphamide, vincristine, bleomycin, prednisone, leucovorin calcium, trimethoprim/sulfamethoxazole DS, ketoconazole
  • ProMACE-CytaBOM – Prednisone, doxorubicin, cyclophosphamide, etoposide, cytarabine, bleomycin, vincristine, methotrexate, leucovorin calcium, concomitant trimethoprim/sulfamethoxazole DS”

And I thought HAART was bad. Do I still want to go into onc? xD

reality

Came across this post…and couldnt agree more (especially with that ONE reason ;)). Provides an important amount of perspective for pre-meds: the comments at the end of the post are also good.

Why you shouldn’t go into medical school–a gleefully biased rant

source

On another note:  more than halfway done with medical school…what?!

And now I really don’t know what I want to do…I really loved Ob/GYN D:

breathe

source

I can’t believe it’s already been 2 months into my 3rd year of medical school–a year that some presume to be the most physically demanding and intellectually straining, but also the most eye-opening. I couldn’t have started it with less of a bang, with general surgery. Needless to say, though going to Haiti didn’t give me much of a break between boards and 3rd year, it definitely prepared me to get back into full-fledged clinic work right away. Thank God again for providing such a great opportunity…it couldn’t have fallen at a better time.

 I went into surgery almost CERTAIN I had ruled it out of the picture, but left actually really enjoying the cases I got to scrub in on. Though the hours were long and hard, I found myself looking forward to every day.  I guess some can view the medical profession as morbid in its fascination with the very sick, complicated patient, but I genuinely loved the numerous complex cases in surgery and was surprised to realize my disappointment in the lesser amount of acute emergencies in ophtho (though I shouldn’t have been surprised). Lately on ophthalmology, I’ve found myself quite bored. At least now I’ve ruled out ophtho 😛 A scary thought is that considering surgery would completely change my plans for the future…so I’m still on the fence about allowing surgery into the picture. But there are fields that involve medicine and procedures too…like gynecology, urology, GI, etc. So the verdict has yet to be decided o_O

3rd year so far has shown me how amazing God’s plan for me has been. I knew I liked science and talking to people, and I figured I would like medicine, but I had no idea going into my program what medicine would entail. Now, having been in the hospital for the past 2 months (and pretty much living there for a month and a half), I’ve realized medicine is quite possible the best fit profession out there for me. God is so good…when I took a leap of faith and went for the program, I still had my mind set on research. But being the clinic has opened my eyes to a field I knew nothing about before…but am so blessed to be a part of 🙂 Thank you God.

May he continue to be my motivation to be diligent! haha 🙂

grocery shopping

a guy beckons to me in the produce aisle at superfresh; i’m listening to the symptoms of polycystic ovarian syndrome…
me:      [takes out headphone] Hm?
man:    [lifts up a huge leaf of some vegetable] Hey, do you think this is spinach?
me:      Umm…hmm…no I think spinach has smaller, more defined leaves…
            I think you can find some over by the wall over there [points]
wife:    See! I told you so!
man:    [Looks at me, then at wife] So then what IS this? [still holding up kale]
me:      I think it’s kale?
man:    Is it greens? [holds up collard greens] Are these greens?
me:      um…I think?
wife:    haha why you askin’ her what greens are? she ain’t black!
me:      hahaha I think those are collard greens.
man:    OK well thank you.
me:     no problem! [plugs in goljan and resumes shopping]

hahaha that made my day xD