Internal Medicine: Day 4

Today was my first day on internal medicine. I'm at a hospital that's new to me (it's huge as well), but I felt pretty comfortable all day. I think I'm starting to fit in with medicine and enjoy this time as a third year med student. My responsibility is to learn as much as I possibly can, and I feel like I'm doing a good job at that. We were only in from 7a-3p, such a short day, and I was pleasantly surprised to be driving home by 3:30. So nice!

My attending is a very good teacher, and she loves to watch us learn and work through problems. We spent a fair amount of time with her today, and she was really helpful in teaching us the basics of internal. She also gave us a motivational speech that I will try to share with you:

"My niece is in the army, and she was struggling through bootcamp. Being about 5'0" and a small frame, it was particularly difficult for her to run the drills with her 50pound rucksack on her back...she called me crying, saying that it wasn't fair to make her carry such a heavy load, she is only a tiny girl and it's much more difficult for her than it is for her 170 pound male peers. You know what they carry in their army rucksacks? An emergency kit, a life-pack that can keep them nourished and alive when they are stranded until rescue can arrive. Of course she needs to carry it, if she can't, she doesn't belong in the army, she doesn't deserve a chance of being stranded without proper supplies in tote! So she has two choices - To quit, or to just do what has to be done. It's not always easy, and for some it is harder than for others, but if you set your mind to it, you can do whatever you wish. I would carry an elephant if it meant that I can get or do what I want. You really can do anything you put your mind to with enough willpower and self-determination."

Then she went to speak about the importance of looking the part of a physician, keeping calm in stressful situations, handling things with tact and care whilst always exuding a sense of competence and confidence. As the leader of healthcare groups, it is our responsibility to handle the stress of medicine with a calm mind and a confident demeanor. She is the epitome of a well hearsed woman, a physician who plays her part perfectly. Which lies in stark contrast to the book which I have finished reading, Delivering Doctor Amelia. The moral of that story was to be yourself, be genuine, don't pretend to be the person that the medical schools rear you up to be. Be who you are, or you will get beaten down by the profession. So I have mixed feelings - be confident and put your patients at ease, or be genuine and be able to live with yourself even after eventual mistakes are made? There surely is a nice balance?

Here are a few of my favorite excerpts from Delivering Doctor Amelia:

Grandad's Wake

As today is Mike's grandad's funeral, I wanted to take some time to reflect...

The first time I met Billy was Boxing Day in 2009. I had just arrived in England that day, my first day I had ever been in the UK. Mike's auntie, Lynda, hosted a little family get together for boxing day (or maybe it was a legitimate excuse for the family to meet this girl who had stolen Mike's heart), and it was there that I met Mike's grandad. As there were so many new people to meet, and I was exhausted from the flight, I don't remember a lot about the first impressions...but I distinctly remember meeting Billy. Mike introduced us to one another, he stood up out of his chair and we shook hands, and although I can't remember all of the words we exchanged, I can clearly remember the big smile on his face as we finished our introductions and he looked back to Mike. He was genuinely and obviously happy to see Mike so happy, to see our young love and happiness. That was one of the warmest welcomes I had received that day, and I immediately felt much more at ease, he made me feel like it was okay to just be myself. Mike has told me lately that this quality is one of his favorites of his grandad; he loved unconditionally, without prejudice or expectations. He was always proud of Mike, loving him for being him. Mike was his first grandchild - and, from the stories I've heard, it seems like the best day of his life was the day that Mike was born: for that entire day, he had a big smile across his face and bragged about his first grandchild to anyone who would listen. As Mike grew up, living near to his grandparents, he spent a lot of his time with Billy, and they were very close. Mike loves his family dearly, and the hardest thing he's ever done was to have left them to be with me in America. In the past 3 years, Mike has often mentioned how much he misses Billy, and he would reminisce on some of his favorite memories of him...and talk about how much he wanted to go back home to spend some more time with him...how he would love for Billy to meet our Marley...how he wanted our wedding in England so that Billy could attend...

Since the approval for emergent travel was not accepted in time (and preventing Mike from being present at the funeral), Mike was asked to choose the song for the funeral. Of course Mike chose "In My Life", a favorite song of the family. Wish we could be there with the family and all of the friends that are grieving this loss.

Do not stand at my grave and weep,

I am not there, I do not sleep.

I am a thousand winds that blow; I am the diamond glints on the snow.

I am the sunlight that ripened grain; I am the gentle autumns’ rain.

When you awaken in the morning’s hush, I am the swift uplifting rush,

Of quiet birds in circled flight. I am the soft star that shines at night.

Do not stand at my grave and cry. I am not there; I did not die.

May the road rise to meet you. 

May the wind be always at your back.

May the sun shine warm upon your face.

May the rains fall soft upon your fields and until we meet again, 

May the Lord hold you in the palm of His hand.

God looked around His garden 

And found an empty place.

He then looked down upon the earth

And saw your tired face.

He put his arms around you 

And lifted you to rest.

God’s garden must be beautiful

He always takes the best.

He saw the road was getting rough

And the hills were hard to climb,

So He closed your weary eyelids

And whispered "Peace be thine".

It broke our hearts to lose you

But you didn’t go alone,

For part of us went with you

The day God called you home.

Internal Medicine: Orientation (Days 1, 2, 3)

The past 3 days were filled with orientation lectures for internal medicine.

On Monday, we had our overview for ACLS training. We went over how to handle a patient who is rushed into the emergency room with an acute coronary syndrome. As I have previously worked on Trauma Surgery, I have actively been involved in the ACLS protocol. A lot of today was review mixed with further understanding of why we give the medications that we do during different ECG waveforms. I was reminded of this one day during Trauma Surgery, when my friend, Steve, and I came in to the hospital at 5:45a and a level I trauma came in at 5:50. We were involved with that trauma until late morning, then went to complete our rounds. Before we had any sort of break, it was 15:00...so we finally rushed down to the cafeteria for a quick bite to eat. After we got our food and just as we sat down, we talked with our other friends about how we had plenty of time to eat, "there was already one massive trauma today", and just then a trauma alert was on the intercom and we had to run off to the Trauma, leaving most of our dinner behind. Ironic. Kind of how life goes!!!

On Tuesday, we had several morning lectures regarding death and dying as well as treatment of pain, shortness of breath, or GI issues in the terminally ill. Difficult things to talk about so early in the morning...but part of our 10 week clerkship includes 1 week at Hospice. I'm looking forward to assisting those who are terminally ill, sitting down and chatting with them and learning all that I can from their experiences. It's not an easy thing to do, I would guess that most med students dread that week at Hospice, but I am looking forward to the opportunity to help and learn from those who have little time left in this world. I have always respected what Hospice does for people, especially after they helped with my aunt, Helen's, final weeks. They are a great organization, helpful with easing pain and providing emotional support to the family.

Today we went over some of the logistics of the hospital, as if we haven't been working there for the past 5 months. I guess it's always nice to have a quick refresher. The nurse who presented this also gave us a lot of motivation, as he really showcased the great things that are going on at our hospital and how incredibly amazing some of our attendings are. One of our cardiologists, a really amazing man with an incomparable love of people and is incredibly patient-centered, has a waiting list that exceeds 2 years. Oh and guess what? I'll be working with him for three weeks in January. Learning from one of the best, how lucky am I?!

My sister had her first colonoscopy today (nothing like a good clean-out a day before thanksgiving!), and she was clear. No polyps. That's great news! We always get nervous when it comes to our yearly colonoscopy date, so scared that they might find something...it is such a relief when they have a clean report.  Our phenomenal GI doctor gave us new recommendations on how to continue to prevent cancer due to HNPCC/Lynch Syndrome, which includes taking 2 325mg of aspirin every day. That research only just came out at the end of October, and he already is promoting its use. He's one of the good ones, glad I can trust him with my health and my family's as well!

My new daily regimen: 

Ob-Gyn Shelf Exam

This shelf exam started off late. We, as usual, had troubles accessing the exam from the national examiners...we were delayed in starting the exam by 2 hours. That's a long time to sit in your seat, nervous and anxious for the exam. Not to mention that we aren't allowed any food or drink - so a 2 hour delay means that I had to wait an additional 2 hours to eat (nearly 5 hours in total). I could have used some caffeine and glucose, you know. I get cranky when I can't snack! ;)

I don't want to jinx myself, but I think this shelf exam was my best so far. I felt totally prepared, and I could think my way through the more complex questions reasonably well.

Every exam is different, so I can't say for sure, but I definitely felt like there was much more obstetric-related questions than gynecology, and they were fairly complicated cases. Maybe I just felt they were more complicated because I was so well prepared for gynecology questions than I was for the obstetrics questions, and maybe they made me feel uncomfortable. I suppose I'll just have to wait and see how I did, I should know in a few weeks. 

Tasty Tuesday - Homemade Naan Bread

Finally, time for another Tasty Tuesday!!! With all of the emotion and stress in our household these last few days, we haven't had much of an appetite...but tonight we were determined to make something nice, hoping that we would be hungry by the time it was ready. So we were back to our old standby - curry. Tried something new, not as nice as our beloved mahtka gosht but it was alright. The real star of the show was my homemade naan bread! Delicious. I love to bake...breads, pies, cookies, cakes...but it's hard to justify the effort and the huge batches made when it's just the two of us! Bread is one of those staple foods that we never let get old though, so it's the perfect thing for me to bake at this point in our lives!

I've made different breads before, but tonight's was just perfect. Must have something to do with the rainy weather, allowing it to rise just right...!

Here's a little run down of the recipe in case you'd like to try it yourself - it is simple, if you're afraid to bake bread because of fear it won't rise or turn out well, this is a perfect bread to practice with!

Take a packet of yeast and add 1 cup of lukewarm water (temperature is important for the yeast to be able to ferment properly). Let it sit for 10 minutes. In a separate bowl: beat 1 egg,  add 1/4 cup sugar, 3 tablespoons of milk, and 2 teaspoons of salt. Add that bowl to the yeast/water. Mix. While mixing, add 4-4.5cups of flour, or until the dough is soft (not too sticky but not too dry)! Then - and this is the fun part - knead the dough for about 8 minutes (side note: my kneading technique looks strangely similar to giving cheat compressions!haha). Place the dough into an oiled bowl and cover with a damp cloth. Allow it time to rise for 1hr.

After an hour, give the dough a good punch to relieve the air. (I lied - THIS is the best part!!!)

If you like garlic in your naan, add about 3 cloves of minced garlic to the dough before you proceed to knead the dough for a few more minutes. Pull off golf-ball sized pieces, roll them to look nice, then place on a tray before covering them with the damp cloth. Let them sit and rise for another 30 minutes.

Finally, take the balls and roll them out into thin pieces, brush some melted butter or oil onto the front, and bake in a 350degree oven for a few minutes. Watch them closely - they go from dough to done quickly!  And enjoy :)))





Yum, I love food made with sincere effort and time!  And there'll be plenty more of that this week - its Thanksgiving in two days!!!! ;)

Final Thoughts: Ob-Gyn

 My third clerkship of third year (Ob-Gyn) has come to an end...

• 5 weeks, 28 days, 267 hours of work in areas ranging from Labor & Delivery, Gynecology, Gynecology-Oncology surgery and Gyn-Onc clinic.
• Working on Labor & Delivery, I averaged about 50 hours/week.
• Working on Gynecology-Oncology, I averaged over 46 hours/week. 
• I enjoyed 7 days off in the last 35 (that's 1 day/week).
• I completed 4 nights on call, which entailed working at least a 14 hour shift from 6p-8a (and up to 24 hour shift) each time.
• I studied Ob-Gyn outside of work a total of 75 hours.
• My total work in Ob-Gyn over the past 5 weeks is: 267+ hours in 5 weeks (53.5 hrs/week...7.6hrs/day).

What I LOVED about Ob-Gyn:

• Being a part of the childbirth process, witnessing the miracle of birth every day, and witnessing when a family is born (or re-born). The miracle of life never gets old, it is absolutely beautiful.
• Patient continuity of care. You get to build a relationship with your patient, and continue to care for her throughout her life, from her first pap smear to her first pregnancy to menopause and beyond. I absolutely LOVE the continuity.
• It's a happy field to work in...most of the time. And who doesn't love some major happiness in each of their days? 
• In Gyn-onc, you can treat every aspect of that cancer - you can diagnose, perform surgery, prescribe chemotherapy, and schedule follow-up appointments after remission. There is no other profession in which you can perform every aspect of cancer care for a patient. That's really appealing...
• Some days its clinic, some days its surgery...there is such a large variety of things to see and do that I would never get bored of it. It is exciting, every day is different.
• Surgery is so much fun. I've said before in my surgical final thoughts blog that one aspect I really love is being able to physically take cancer out of someone's body. And you can definitely do that in Gyn-Onc. But what's even more rewarding is taking a baby out of the uterus when the mom cannot give birth vaginally - it is a thrill. It's the fun of surgery without the testosterone-dominated surgeons! ;)
• I love to take care of women. Many women are too busy being super-moms that they forget to take care of themselves, and that's where a good Ob-gyn comes in to help, giving advice on how to better care for themselves, to check to make sure they are healthy, and to give them some preparatory advice on what they can expect as far as womanly changes as time goes on. And they listen, and interact with the interviews. It's a lot of fun to sit and chat with them about their health.
• I fit in so well with the Ob-Gyns, my personality fits with this specialty. These physicians, which are predominantly female, dress well, wear makeup, eat healthy, work out, love their families, and work hard. They're very hard-working, take their job very seriously, and they also have such great communication skills and are able to talk with their patients on such a caring and understandable level. They are so patient-centered. They adapt to suit the patient's desires. They are also hard-headed, some may say stubborn, and believe strongly in their work. And they're funny, and they have fun with their jobs (while maintaining professionalism). I see so much of myself in these physicians...it really would be such a great fit for me...
• The number of prescriptions that I need to know inside-and-out is small, basically consists of antibiotics, pain relievers, hormone replacement therapy (including birth control, menopause therapy, and ovulation induction), anti-inflammatory drugs, and some hypertension and diabetic medications. 
• ...I feel like I could go on about my love of this field, but I'll stop myself since I have the major things listed!

What I DIDN'T love about Ob-Gyn:

• Babies can be born at any time of the day...or night. And the mom wants HER ob-gyn there for the delivery. So the hours can be crazy, you must be on-call literally all of the time. 
• The ridiculous amount of malpractice involved in Ob-Gyn. You can be guaranteed to be sued at least once during your career as an Ob-Gyn...but not to worry, the malpractice insurance costs are high enough to cover when that happens...! When bad things happen, they can be very bad...
• I couldn't help half of the population - that is, I would be totally useless in any male problem. I like to care for men as well as women, so I'm sure I would miss that if I chose Ob-Gyn. 
• The work load is high, the expectations are high, the malpractice costs are high, the training is long...but the pay does not exactly match these difficulties. I'm sure I would be able to live on the pay (could you imagine, six figures!?), but I do think they deserve more than they get when you consider the stakes. 
• Not a fan of the increasing obesity epidemic - increased rate of endometrial cancer, and it just is not a nice thing to work with...and I'll leave it at that!

So for now, I can safely say I will NOT become a pediatrician or general surgeon...

I love Ob-Gyn. I think it's at the front of my choices, right beside hematology-oncology. And, after the pain of peds, I definitely have my passion and love of medicine back!!!

Grandad

Today was a rough one. My shelf is tomorrow, so I've been busy with revision since the early hours of the morning. I'm feeling quite confident, I think this shelf will be my best one yet! I'll be sure to let you know how it goes tomorrow!

Mike got the phone call from his parents that we have been dreading - his grandad passed away this morning. He had been battling Parkinson's for many years, but this past year has been especially rough. In May, when Mike and I just arrived in England, he had a pulmonary embolism (a large blood clot in the pulmonary artery that causes blood flow into the lungs to vastly decrease, thereby causing a large decrease in the oxygenation of the blood and subsequent decreased perfusion to the organs), from which he slowly subsequently recovered...but he hasn't been able to return to his prior state of function, due to his progressing Parkinson's, which became refractory to medication (his body had built up a tolerance to the drugs which had helped him to function well for so many years). In the last few months, he has had a hard time with more of his motor function, to the point of affecting his ability to swallow, and he had a gastric-tube placed into his stomach. All the while, Mike has been here in the states, wanting to return home to be with his beloved grandad one last time. We had hoped that the green card would be approved before this, but life never happens as you plan...we are working to get an emergent approval for travel outside of the US so that Mike may return home for the funeral. Mike and his grandad were so close...words can't express how deeply he will be missed...

I do apologize if that explanation sounds a bit...brash?...but I have found that I detach myself from the personal side and describe things a bit more objectively since I have starting working in medicine. It makes the pain of losing someone sting a little less. I'm not sure if that is a good thing or not...

It is at times like these when I am annoyed with med school. I want to be there for Mike, I want to speak with him about all of the wonderful memories he has of his grandad, I want to be there with him at the funeral, I want to support him in the way that he has always supported me...but I cannot. My exam is tomorrow, so I couldn't spend the time with him that he deserves today. And if he goes home for the funeral, I can't come with him, as I could never get a week off of work, no matter how important of an excuse I may have. I want to be there for him, I want to make things better, but all I can do is my work. It is such a conflict; I am at least thankful that he understands that I would love to be there for him but I cannot. I might not be so forgiving of myself...I don't like the idea that medical school and my profession might harm our relationship, or put huge strains into our life. I can be deprived, I can make sacrifices for myself...I am okay with that...but I hate the idea that the sacrifices I have to make hurts my ability to be as good to him as he is to me.

Fingers crossed for quick approval for Mike to travel home to be with his family...

Marley always has a way of making us feel better...

Marley hugs:

OB-Gyn: Day 19

Yesterday was (unexpectedly) my last day of my Ob-Gyn clerkship. We were in clinic after doing our morning hospital rounds. Two of the three patients I had prepared to see in clinic did not show up to their appointment (totally frustrating), but the one patient I did see was more than enough to handle.

The patient was a nearly 60 year old female with an incidental finding of microscopic hematuria and a pelvic mass. She is a chronic smoker (at least a 44pk/year history). She was completely asymptomatic...or maybe she wasn't. The reason I say that is because I honestly don't know if she would notice any changes to her body. She was very, as my attending described, "simple". She also appeared to be much older than her stated age. I attribute much of that to her chronic smoking. After taking a full history and performing a physical exam, we weren't too concerned of the mass on her ovary being cancerous, but we would like to take it out any way, to make sure that it is truly benign. You would not believe how difficult this was to explain to the patient. Suddenly, after the word "surgery" came out of our mouths, she burst in to tears, exclaiming that she doesn't want to die on the operating table. How do we get across the fact that every year in the US we perform over 600,000 of these surgeries and that there are very few complications? That the likelihood of death is almost zero? It was when these thoughts were in my mind when the daughter stuttered the words "a-a-and if s-s-somthing were to h-h-happen to --her when she's in s-s-surgery, w-w-who's liable? I-I-I mean, i-i-if she d-d-dies, I'm gonna s-s-sue e-e-everyone". Wow. Nightmare. Your risk of dying on the drive to the hospital is probably higher than it is of dying on the operating table. How do you explain that? How can you possibly dim down medicine and surgery to the point that people who have an IQ of 70 can understand? I felt so horrible, because I had no idea how I could explain it any simpler so as to put her mind at ease. The patient was sat there, on the examination table, crying her eyes out while her daughter was talking about suing us after she dies on the operating table. Not exactly helping the situation. I felt so horrible for the patient. How do you convince her that she will be alright in words that she would understand?...

I went to a review session last night and was told that we don't have to work any more this week, we can have the two days to study and revise for the shelf exam on Friday. So I better get to it. Apologies for skipping out on Tasty Tuesdays for two weeks straight; I know saying I'm busy isn't a good excuse because I'm just as busy as always. But I'll have a think and make something extra special for next week, promise! :)

OB-Gyn: Day 17 & 18

One of the most emotionally difficult days of third year...sit down and let me tell you all about it...

There is a patient on our service with an endometrial cancer. Today was around a week since her surgery. On admission to the floor post-op, we put her back on to her home med of coumadin, but added fondaparinoux (arixtra) and ordered for daily INR. The INRs were not done, so we were never aware of how "thin" or "thick" her blood could be...not that it makes a huge difference on what was to come... She coded before we came in to the hospital today, and was revived by the team and transferred to the ICU. We replaced lost clotting factors, loaded her with fluids, gave her vasopressors, put her on ventilator settings, gave her blood/fresh frozen plasma/vitamin K/albumin etc etc etc. Critical care is an understatement, this patient got the works. And my fellow med student and I kept a careful eye on her all day. Every half hour or so we'd stop by and check up on her, look at her labs, speak with the physicians, talk with the nurse... whatever it was that caused this to happen, we felt partly responsible, so we wanted to be there for her to help her get better. Even after 14 hours in work, I am sat here at home thinking about her, wanting to do more. But not so long ago this evening, she coded and CPR was stopped. It feels like such a failure.

While she was being aggressively resuscitated, her blood pressures couldn't tolerate sedation, so she was completely conscious earlier today. We didn't realize that she was conscious until my partner put her hand on the patient's hand, and the patient squeezed back. What a horrible thing, to see someone trapped in their body, on a vent, in agony, bleeding out... horrible. I feel like we let her down. While she did have an extensive list of health concerns, I can't help but feel like I could have helped to prevent this. But such is life. Death is hard, especially when it occurs unexpectedly.

After work, I had my OSCE. I had to perform a breast and pelvic exam on a standardized patient. I did well. The evaluator and the patient mentioned that I did a great job in explaining things, I made them feel comfortable, and I came off as very professional. The attending then told me that I am "obviously a people person; you should definitely go in to clinical medicine - what field are you interested in?" (I replied "oncology of some sort"), and he said "hmm, maybe gyn-onc! You should consider it." I do love feeling like I would be an asset to the program, feeling like I am being recruited. I definitely feel like I belong. He also said that oncology was a perfect field for me. It's so nice to hear those words come out of such an experienced and knowledgeable physician.

It's been a long, hard day. Time to snuggle up with my doggy and watch her favorite movie, "Lady and the Tramp". Marley has a way of making me feel better, no matter how bad my day has been...

Inside the MS3 Studio

James Lipton hosts a program called "Inside the Actor's Studio" during which time he interviews actors on a more intellectual basis when compared to most. Before each interview closes, he poses the same 10 questions to each guest. I thought I'd take some time and fill in my answers to those infamous questions.

1. What is your favorite word? "Enthusiastically" both for its phonetics as well as its inherently uplifting feeling.
2. What is your least favorite word? "Disappointment", for it is truly one of the worst words to hear.
3. What turns you on? Good music. It can be any genre: pop, motown, country, rap, rock and roll, oldies, classical, seriously any type of music - and I am always affected by it. Good music excites me.
4. What turns you off? People that complain incessantly. I mean, come on, your life really can't be that bad...but to that effect, I also am really turned off by people who, what I like to call, "polish shit" - they make their life sound much more glorious than it actually is. I mean, come on, I know your life can't be what you try and make it out to be.
5. What sound or noise do you love? A newly born baby's cry. It just tugs on the maternal heart strings.
6. What sound or noise do you hate? Metal on metal scraping sounds. Horrific.
7. What is your favorite curse word? I always feel the urge to giggle when I hear the word "bollocks"!
8. What profession other than your own would you like to attempt? I would love to be a missionary physician, traveling to poor places of the world to give free healthcare. But if I can't choose another healthcare occupation, I would say a musician - an unbelievably talented pianist would suffice!
9. What profession would you not like to do? I would rather do any job in the world than be unemployed. To be stuck in the house without the opportunity to interact with others is, for me, nothing short of torture.
10. If Heaven exists, what would you like to hear God say when you arrive at the Pearly Gates? "In life, you were a true inspiration to others, a real role model of humanism who made such an impact on so many lives."

It is now officially my last week on Ob-Gyn. I'll be sad to finish this clerkship, I have had such a great experience! Just need to memorize everything in these 2 books and my notes...

Home Sweet Home

Happy weekend! Loving this 3-day weekend stuff (even if I do have to go in on weekends to round on my patients - it still feels like a full 3 days off). Yesterday was such a good day, even though I was stuck in the dentist's chair for most of it. 2 hours filling in 6 cavities. I haven't had a cavity in years, but when I went to my first consultation for Invisalign, I was told I had 9. So I went to my primary dentist, and he could only find 6. Many of them weren't cavities yet (there are stages of caries - just beginning into the enamel, through the enamel, and into the dentin or beyond). 2 were into the dentin, which need to be filled, but the other 4 were prophylactic fillings. Since I'll be using Invisalign for the next 2 years, I won't be able to have any dental work or fillings during that time, so we had to prevent any possible problems by taking care of anything that showed even beginnings of a cavity. I just hate having cavities; I am an absolute OCD teeth-brusher, but I some how end up with caries. After that fun, I went to visit my dentist for the fitting of my Invisalign. They took a bunch of impressions of my teeth, which will be sent to the headquarters of Invisalign where they will determine and process my specific treatment plan. I should get my first set in 4-6 weeks - fingers crossed it will be before Christmas!!! I am so excited to have straight teeth!!! :) :) :)

Anyway, we had a really great night celebrating true love with our good friends, Ben and Gina, as they celebrated a special day. I love being reminded of how amazing love is, how lucky we are. They are such a cute couple, I love to see them so happy together. Love is a beautiful thing...

So today I revised Ob-Gyn in preparation for my impending shelf exam. We also did some fall cleaning, and now we're ready to start putting up some Christmas decorations!!! I'm so excited to spend Christmas with my family this year! Celebrating away from our home and in a different culture was a lot of fun last year, but I missed the traditions and culture I enjoy at home. I'm looking forward to being home for the holidays, with my fiance and puppy. We're trying to do 1 Christmas in the US, the next in the UK, and so forth just to split the time up equally. It's always going to be a struggle, loving someone from somewhere so far away. But it is so most definitely worth it! :)

I wanted to share our home with those of you who have yet to visit the place we call home. We can't even begin to explain how excited we are to have all of our family and friends together for our wedding, to have all those we love in one place and able to meet each other. And that is nearly exactly 1 and a half years from now! Crazy!!!

Here's a video of our apartment. Mike said I went "proper American" on the commentary...well, sorry love, but I am! ;)

And if you wanna see more of where we live, please please stop by and visit! :) :) :)

OB-Gyn: Day 15 & 16

The last two days have been hectic to say the least. On Wednesday, we were in surgery all day. We had a case where we did a TAH + BSO + Lymph node dissection + Panniculectomy. TAH means Total Abdominal Hysterectomy - it is the removal of the uterus. BSO - Bilateral Salpingo-oophorectomy - removal of the Fallopian Tubes and Ovaries from both sides. Lymph node dissection for an endometrial carcinoma includes removal of para-aortic lymph nodes, pelvic lymph nodes, omental nodes, and maybe more (if any feel palpably enlarged). Panniculectomy is a tummy tuck - a removal of a portion of abdominal skin and its corresponding abdominal adipose tissue (fat). This patient was morbidly obese, and removing a portion of the skin/subcutaneous fat will improve the quality of her life by removing the yeast infections that proliferate beneath the skin fold. It weighed about 20 pounds, and I got to remove the final piece of it and transport it to the scale to be weighed. It was cool. And I definitely don't want to eat McDonald's or fast food or greasy crap junk food for a long time. Yuck!

The attending gave us some advice in determining what we want to do with our lives. First, you need to decide how much you want to work with your hands - A lot (such as a surgeon or Ob-Gyn does), Sometimes (such as an anesthesiologist), or Not At All (such as an internist). After you decide how much you want to work with your hands, you need to determine what you love to read most. What excites you. What you can't help but read about and learn everything about. And for me, that answer is easy - I love oncology. I seriously cannot learn enough about it, it excites me and motivates me. I absolutely love it (and by love I mean have a strong desire to help cure those with cancer). So I think I have decided at least a field that I know I want to go into - Oncology. I have always known it would be oncology, but now I am so confident about it. In clinical practice it excites me as much as it did in didactic education and research. I am so relieved to have at least determined what field I want to go in to. Seriously, I was starting to doubt whether or not I would ever just know where I wanted to end up. They say you figure it out in 3rd year, you just know, things just click and -BAM- you know what you will do with your life. And I do. Now I just need to decide if I want to do a surgical oncology (I really do love gyn-onc) or medical oncology (I do love hematology as well). Guess I'll figure that out in my next rotation in Internal Medicine!

It's a rough life, eh Marley!

OB-Gyn: Day 14

Exhausted...another 12+ hour day. Hospital rounds, morning clinic, afternoon clinic, and then a surgery before coming home for a quick shower, some revision, and now blog then bed. Exciting life! No but really it was a great day. Saw a new patient with highly likely ovarian cancer, saw another patient in clinic who I was following on the hospital service previously. This afternoon's surgery involved placement of radiation rods for vaginal cancer irradiation. That was a really interesting surgery. Well worth the extra hours in work to participate in that surgery.

The resident I am working with asked me if I had a boyfriend or married and I said yes. Then he asked what he does and I told him that he's from England, so hes dealing with immigration issues at the moment... Then asked me how I met someone from England, and I said what I always say "he randomly was in chicago with his friends, I was randomly in chicago with my friends. we just happened to meet, and it was love at first sight." The resident smiled, his eyes softened, and he said that he met his wife in chicago (neither of them were American yet they randomly met in chicago). What a special moment, sharing such a special and unique story with my resident. Talk about instant connection!

Only a few days left of OB-GYN... STILL Can't believe how fast time flies...!

OB-Gyn: Day 13

A friend of mine recently read a few books which have been on my book list for months - Delivering Doctor Amelia and Moms Marijuana. Thanksgiving plans include these two books, especially after I read a little preview of them. It's made me feel validated, like I'm not the only one who feels like I'm drowning in the sea of medical knowledge. It's natural. It's expected. And it's all part of the beauty that is medical education. I will keep my smile on my face and keep doing my best, and the rest will fall perfectly in to place.
I wanted to share the excerpts of the book with you. Enjoy!

"Doctors are a strange breed. They nibble at an overwhelming amount of information in medical school. They are too bright to miss the incredible distance between what they know and what there is to know. They dedicate their waking hours to memorizing droplets from a great ocean of information. They learn trivial anatomical structures and then promptly forget them. They stand with groups of more experienced physicians and are asked questions they don't know the answers to. They shake the sleep from their eyes and walk down neon-lit halls feeling inadequate and small. The Ben Casey vision of medicine that propelled them through organic chemistry classes in college crumbles in the face of a reality which includes cureless diseases, obnoxious scut work, and constant humiliation. They wear down. Their lovers wear down and leave them at higher rates than in most professions. The one untarnishable thing they have left is their basic fascination with the human body and what can go wrong inside its miraculous design.

Inevitably, they lose their empathy for pain. The waterfall of pain they hear from countless patients wears them down to smooth rock. After all, they have had to deny themselves so much to succeed. They have endured their own painful humiliation. They have learned that pain is simply a warning mechanism, it isn't real. Is it any wonder that our painful cries empty into a vacuum when doctors are in the room? Is it any wonder that they sometimes forget that we are not our diseases, that to treat our diseases they must also treat us? Is it any wonder that they forget to treat our terror, that they forget to treat our lover's terrors, that they forget that we need soothing and a pat on the shoulder?

Oncologists are drawn to the good fight, to the opportunity to fight a monster on the front line. They are drawn to the magic of rescuing a life from the jaws of the enemy, but soon they find the faces of their patients haunting them. No one has taught them that they need to talk about their losses, that they must mourn the deaths of the patients they grew so fond of. They haven't learned that to survive they must find ways of debriefing themselves. When reaching for the peas at a family dinner, while casually looking into the rearview mirror at a stoplight, or while watching their toddler bound across the kitchen floor, intrusive snapshots of interactions with patients, now dead, sneak into their consciousness. These visions are potent warnings that they should not get too close to their new patients, that they should erect a screen.

But we patients sense these screens. We study these strange beings almost as carefully as we did our first love. Every subtle move of a hand, every nervous cough, every wrinkled brow, captivates us and we play them over and over again in obsessive ruminative detail. Oncologists are our oracles. We wonder if they have seen our futures. We try to engage them, hoping that perhaps an extra few words will help them commit more energy to our struggle.

I always feel a pang when I meet a new oncology fellow. They are new to the front. They have seen the falling shells as residents, but now it will be different. They will have more autonomy. They will make life-altering decisions. They will begin to root for the patients, as much as for their own sense of competence as for the patient's health. And when a patient dies, a piece of them will die. They'll wonder what they should have done differently, caught earlier. And they'll stand near the coffee machine muttering about incurable diseases, sounding too professional, and then sneak home and bury their faces in their pillows.

For doctors death is the ultimate enemy. Death is not the end result of all life. Death is an unnatural force that steals promising patients away in the dark of night. Death is messy and abrupt. Death is not to be talked about. (Death might show up if you call its name too loud.) Our fears of death only remind the doctor of the ocean of knowledge he never learned or long ago forgot. Death reminds him of the futility of his efforts and his own eventual demise. And isn't his work enough without being reminded of these dreadful things?"

Another gorgeous sunset to end another beautiful day! :)

OB-Gyn: Day 12

This is part of a photo that is up in the front lobby of the hospital I was at for labor and delivery. It's a much needed reminder that what is more important than knowing is the desire to know more. Stop focusing on everything I have forgotten, and focus on learning as much as I can now...

Saturday was my weekend call. We rounded on our hospitalized patients then were free to go home. We went over the importance of the traditional side of medicine, the usefulness and necessity of understanding vital signs and patient interaction. In this day and age, so much emphasis is placed on the newest technology - CTs, MRIs, Mammograms, Biopsies, Labwork... The attending suggested that vital signs and patient interactions need to be at the forefront of our care, and we need to rely less heavily on newer technology. This precisely mirrors the philosophy of medicine in England, and I could not agree with this more.
I would love to talk more, but I need to revise! My shelf exam will be here before I know it...

OB-Gyn: Day 11

Today was a clinic day. After rounding on our hospitalized patients first thing in the morning, we spent the rest of the morning in clinic. I saw a patient with vulvar cancer (with a mucocutaenous flap to cover the excised, cancerous tissue), endometrial cancer, and a few GI-GU fistulas (rectovaginal fistula). The patients have been really nice, and I am learning a lot from their experiences. I really enjoy the oncology side of OB-Gyn.

We spent the afternoon going over many different topics and relevant cases covering the OB-Gyn service in preparation for our upcoming shelf exam. Sometimes I feel like I have so much to learn that I will never be able to know enough. I haven't had any problems with the exams, in fact I've done well so far this year, but I still feel like I don't know anything. I remember not so long ago when I thought I was the smartest person in my high school. Then I went on to think I was one of the very smartest in college (I have the grades to back these claims up). But then I started medical school, surrounded by people just like me who have always been All-A Students, top of the class, well-known for being gifted intellectually, and I realized that I'm not all that special. There are loads of people with good grades, who are incredibly smart, and now I compare myself against them. And suddenly I'm not the only smart one, and I feel like a failure. When you're used to always being correct without much effort and you suddenly switch to getting questions wrong here and there, it feels horrible. I don't know how I will ever know all that there is to know as a physician. But I do know that I will never know it if I don't have confidence in myself...so I'm working on that. It's just ironic that my high school classmates would talk about how I was so arrogant about being smart, and here I am, the truth comes out, I'm not arrogant at all. Give it a few years, then maybe I will be!haha you know, the whole "doctor-god complex"! ;)

We went to a few parks to walk the dog after work. Marley had a great time.

Mike's appointment went well this morning, his fingerprints and photographs went through without any problems. Let's hope the rest of the application finishes soon!

OB-Gyn: Day 8, 9, 10

I'm not really sure where October went (or the rest of the time since June), but here we are in November already. Third year of Med School is really flying by...

My final day on Labor & Delivery was Tuesday. Nothing too extraordinary happened; I actually didn't see a single delivery. I thought there would be a sudden rush of births, being such a good day to be born (11.1.11); but then again, maybe those kids are waiting for the big 11.11.11. ;) I really enjoyed my time on L&D. There is something so inspiring and uplifting about new life. To see the mother and father's love in their eyes while they wait for the baby to decide to enter the world...to see the father hold mom's hand and offer encouraging love and support while in labor...to watch a mother hold her baby in her arms for the first time...to see the tears in a father's eyes when the baby starts his first cry...it is truly an amazing experience. I was fortunate enough to have witnessed more than 20 births in my 7 days on L&D, and I know that it is an experience that I will never forget. How beautiful.

The past 2 days have been spend on Gynecologic Oncology, which is where I will spend the next 2 weeks of my time. While I'm not a huge fan of pelvic surgery, I do love the atmosphere of Gyn-onc. People are so loving, so committed, so patient-centered, it revives my passion for medicine. And just mentioning cancer makes my ears perk up. I'm starting to feel like I have narrowed down what I will do with my career. I feel like I was put on this earth to help those in their most dire time of need, when they need someone capable of handling the enormous physical and emotional changes that cancer presents... I am relieved to see that what I have always thought would interest me actually does. I get so excited by oncology, but the physiology and the management, the emotional aspects and the necessity of being the absolute best in order to save lives. Luckily, I am now surrounded by two of the best gyn-oncs in the nation. They are brilliant. They are incredibly patient-centered. They are devoted. They are committed. They are perfectionists. They are current. They are researchers. They are teachers. They are friends. They are people to strive to emulate. I am so lucky to be working with them. I know that I will learn an incredible amount from them, and what is more important, I know that what they will teach me will be the best evidence-based medical practices available.

Today, I was mistakenly called a doctor on 5 separate occasions. A girl could get used to this! ;) Best quote of the day "I can't tell you how relieved I am to have 4 women doctors taking care of me!" Just another reason why I love OB-Gyn - patients love to see a caring, female face! :)

I miss spending time with Mike and Marley. I miss having time to see my family. I miss seeing my friends. I miss working out. I miss cooking. I even miss cleaning! I miss having a normal life. But I absolutely love medicine, I adore the difficulty, the thought, the complexity, and the responsibility of it. I could never do anything else as a career; this is definitely my calling. I love it so much that I don't even complain about the 80 hour work weeks!!! (but I know sometimes I want to complain about how tired I am - but I don't dare to complain too much for the residents work longer than I!).

Seriously, how can you not love this face!?

Mike gets his fingerprints and photos taken at the USCIS office near us tomorrow. Fingers crossed for quick processing (no pun intended!)

Tasty Tuesday

This week, I would like to share with you one of our absolutely favorite meals, Matka Gosht Indian curry. It is one of the most spicy things I have ever tasted, and it is full of flavor.

We have the spice mix pre-packaged, and purchase the spices and the lamb from our local Arabic shop. The guys in there love Mike; it's amazing how they can spot any bit of Arabic descent in one another. I laugh when they try to speak in Arabic to him - the few words that he knows well don't amount to much in terms of conversation.

We fry several chopped onions and a few minced garlic cloves in a healthy amount of olive oil before searing the lamb. Then add in the spice mix, pour in a few cups of water, and let it simmer for several hours before adding some flour/water mixture to thicken. Continue to heat for another 30 minutes or so while you bake the homemade Naan bread, then enjoy the curry over a bed of brown rice (or on its own with a bit of Naan to dip). This meal is a staple; we make a huge curry at least once a month - and the one recipe lasts for about 4 separate meals for each of us.

Yummmmm, seriously I could lick the screen, it is so good. It might not look like much, but it is oooooooh soooooo good!!! Especially when you're struggling with a bad cold ;)

I wasn't a huge fan of Indian food before I came to med school/met Mike. A lot of med students love Indian food, and of course the British like to claim it as their unofficial national food, so I have definitely come round to the unique flavors in the cuisine of India. I actually crave it sometimes, and its nice to have a great curry recipe on standby for such occasions!