Addendum: Reflections of a a medical student who went abroad for her MD

I have wanted to write a post about what it was like to be an IMG and the pros/cons of going off-shore for an MD for some time. Yes, officially I am done with this blog but for those future SGUers that may be reading later or lurking this post is for you...

My List of 10 Things to Consider:

1. SGU or another Caribbean medical school (but be careful because they are not all created equal) offers you a chance to earn your MD, a CHANCE to become a doctor. Getting accepted and going to SGU is by no means a guarantee that you will achieve your dream. I think this is an important point to make and for future and contemplative students to understand. I could tell you about a boy that came to SGU but left after a term because it was just too hard, I could tell you about a girl that left her fiancé to attend medical school and could not figure out how to be in a relationship with 1500 miles between her and her betroved. I know a student that left and is now in PA school. I personally know several people that despite graduating are unmatched and trying to figure out a way to secure residency in 2014. The say the hardest part of medical school is getting in. That may be true for US schools but I would not same the same for SGU.

2. Medical school is hard. You have to want it. And you have to be doing it for yourself. Otherwise, see above.

3. Even if you succeed and graduate, you MAY NOT MATCH. This is the truth and it is sucks. So if you have options, are young or simply don't want to be in this situation figure out how to get into a US Medical School. Go to DO school. Get into a medical masters program and try again. Being an IMG is a disadvantage and unfortunately this situation is only going to get worse.

4. You are one of many. The class sizes are large and growing each semester. There were 418 students at my white coat ceremony and another 86 that joined us second year from the Global Scholars Program in the UK. That means I am one of 500+ students in my term. The good- you can find your own click, study group, friends, out of 500+ this just happens. The bad-you never know everyone, you may rotate with fellow classmates that you never knew on the island. The professors and faculty will not know you unless you happen to do research (which is no small feat during the basic science years) or go to office hours incessantly. Individual attention is not going to be given to you so if you need small class sizes or personal help think twice before choosing SGU.

5. Your medical school only exists as an umbrella. Once you leave Grenada there is no campus, no SGU events or official student get togethers. You must seek out your own mentors and get advice on how to apply for which residency. For me this was not much of an issue as I was already decided that I would do Child Neuro and Dr. Boyfriend had gone through the whole process so I had support and mentors from my past research job, etc. For some students this was difficult and they struggled figuring out what they were going to do, what to apply for, how many program to apply to, etc. US medical schools tend to have academic advisors and small groups of students that meet throughout the four years and this type longitudinal support is lacking at SGU.

6. Medical school is DIY. I am sure that this is somewhat true for all medical schools but being an IMG in a class of 500+ students accentuates this aspect. There is no personalized instruction or mentoring. Sure you have an assigned faculty advisor but this is mainly lip service. I  was able to meet with mine a total of two times in two years.  One of the meetings was a lunch for all of the advisees. My advisor did not know my name. When I emailed him, his secretary responded. I had friends that had slightly more involved academic advisors but it really comes down to the fact that there are SO MANY students and that you are only on the island for two years. Resources are limited in this regards. Once I left the island I thought maybe I would find a clinical mentor but since I rotated at nine different hospitals and was continually moving this was a difficult proposition.

7. You have no medical center home.  I was continuously changing hospitals during my clinical years.  I rotated in county, state, community, private, and inner-city hospitals and saw a variety of patient populations. In doing so I learned different ways of accomplishing similar tasks. I believe this was a huge advantage and as I interviewed for residency I was able to apply my knowledge of different programs and know what I was looking for. Learning a new computer system or finding my way around the hospital was no longer a daunting task but simply part of each new rotation. Sure it was a pain to live out of a suitcase and move every 4-12 weeks but I liked the variety and exposure. For some, this is a disadvantage and there are work arounds.  Note, you can choose to stay in one area but if you do this then you are limited to some of the less desirable places to train, in my opinion. I think moving around gives you a more diverse education better chance to network, etc. This worked for me but it was not always ideal.

8. You get to live in a foreign county. This was good and bad. I loved the experience and enjoyed Grenada. Many of my classmates did not. I missed my grandmother's funeral. I missed many birthday parties, weddings and family Holidays. There was no option of going "home for the weekend". This means that I was freed from many social obligations but it also meant I missed out on those special family moments. I lived away from my husband for two years and we joked about our "marriage by skype" this worked for us, but it was difficult.

9.  You will most likely enter primary care or IM. This is simply a fact. If you desire to become a neurosurgeon or a dermatologist than SGU is not for you. Sure a token few in the top 5% of the class will match into a couple of highly competitive residencies but the vast majority (over 70%) are going into Family, IM and Pediatrics. Surgery, ER and anesthesia are possible but very competitive. This is the reality of becoming at IMG. (Note-I based my calculations on the 2013 match list with a denominator of approximately 700.)

10. You will be in debt (unless you are a trust fund kid or have independent wealth of course). This is really not unique to SGU as all private medical schools are expensive but living in a foreign country and having to move around during 3rd/4th year adds to the expense. My medical school debt is over $350,000. I just finished my exit loan counseling and my monthly loan payments will be over $2000 (which is the graduated 20 year plan.  Note, you do have the option to defer these loans during residency and accumulate more interest or pay based on salary but these options only apply to Federal Stafford loans not any Direct Plus or private loans you may have taken to subsidize expenses or apply to residency, etc.)  Also note #9. As a PCP you will not make the big bucks to pay off your loans so unless you do a loan forgiveness program you will most likely be paying off your education for a very long time. I never really thought of this aspect or spent too much time worrying about the debt that medical school requires as money was not my reason for choosing the field. Yet I now believe this topic is worth the mental exercise.

If you can be happy doing something else, do it. If not, well then choose carefully, have a plan and may luck be with you!

The End...

The time has come. This is good-bye.

It is hard to believe that I started this blog over four years ago. It hardly seems possible that so much time has passed. I went to Grenada. I came back to the States. I took Step 1 and 2 and CS and did my clinical rotations. My grandmother passed away. My father had heart surgery. We got a puppy and he turned one. I figured out what I wanted to be when I grow up. I applied and matched into what I believe will be be perfect residency program for me. I made amazing life-long friends while I ventured to a foreign country and back. I regret none of it and would do it again in an instant.

Medical school is over. Complete. No more. I don't even think I know what that means. Someone called me "Doctor" yesterday and I started to correct him but then as I thought about it, well technically.... wow. I don't think that has sunk in yet. I mean I feel that I am done with being a student. But am I ready to be Neuro Chick-Kid Doctor? I don't know but I hope so?!?! Regardless of how I feel I WILL be. And in just seven weeks time.

I finished my last rotation and today I get my diploma (officially it is dated today, I won't actually get it in the mail for another week I suspect.) The graduation ceremony is still a month away but by then I'll have moved to Texas and started residency. So this is it.

I don't have anything profound to write or an amazing finish for this blog. But thank you for reading and accompanying on me over the past four years.

I do plan to continue blogging and will post a link to my new blog soon but for now, good bye. I am signing off. Cheers!

Not a fairy tale but something like that

Life may not have fairy tale endings of happily-ever-after.

But....

Plus, there is happiness if you know where to look.

I have just two days of medical school left and I recently found out that my first medicine patient is home and no longer on dialysis. This is good news, the best news possible! I expected for him to be on a kidney transplant list or worse by now. But instead he is living his life and his kidneys are functioning well enough to allow him to skip dialysis. He is so young and has so much life ahead of him. I can only hope that he gets to live it.

I also found out that one of my neurosurgery patients is making amazing progress at rehab. Prior to being a neurosurgery patient he was an amazing, smart, able-bodied father and grandfather. And then he fell off a ladder while doing some home repairs. He left the hospital with very limited control of one extremity and was largely non-communicative with a trach and G-tube in place. I  really didn't know know what kind of life he would live again.  However he is now in a wheelchair, wheeling himself around, as well as eating and talking. I saw a video of him yesterday and could not believe it was the same patient that graced the service the entire month I was on.

I am so glad I have some happy patient stories to end medical school with. (I have plenty of not so happy endings to share too, but not today.)

Today is about reflecting on the good.

The amazing, brave and resilient patients I have met.
The thoughtful and helpful nurses and staff.
The dedicated professors and attendings.
The mentors that have taken the time to inspire and help me become who I am today.
My wonderful support system: my husband, my parents, my dear friends.

I did not get here by myself. The end of medical school is around the corner but it is not my celebration alone. I appreciate everyone who helped me along the way. There were dragons and they were slain.

Life may not be about fairy tale endings but my end of medical school is happily-ever-after or close enough to it for me.

total apathy and mid-night realizations

I have the worst case of senioritis. I am so unmotivated to go to work and once there I really have to try to care because right now I just don't. I am doing a month of cardiology as my final elective and while it should be interesting and good review on reading ECGs I simply find it torturous to be tied to a pager waiting for the next consult to come in. I really don't have much love for CHF or the intricacies of transesophageal echocardiograms. I am going to be a Child Neurologist and I am SO excited to see kids and think about the brain, however adults and their hearts, not so much.

I wrote these words a day or so ago and while they were true at the time and remain so there is a small caveat. I think that 90% of why I am "checked-out" other than the about to graduate thing is that I am bored to death. I actually had a real-bonafied, my patient is having an STEMI consult and the ER really did need a cardiologist and I woke up from a dream thinking about my patient. And the fact that I was at work almost three hours beyond the normal pager time didn't even bother me. Because I do like medicine and learning and when I feel important/needed/useful and even more so feel that the patient is benefiting from my time then I am more than happy to be at the hospital. It is just that up until yesterday most of the consults were a waste of time.

Seriously, I've had consults such as: patient with new onset V-tach, non-symptomatic, unsustained for 8 beats in the middle of the night. Please evaluate. Guess what? Motion artifact. You wasted an hour of my time and 10 minutes of my attending's time so that we could tell you that your consult was BS. I guess this was due diligence and now I will hopefully never make the same mistake so I did learn something but this happens all the time!

Surgical clearance consults. Yes, they have to be done but please don't ask Family Medicine to do the consult and Cardiology to do the same consult. We both show up and then feel obligated to do the consult because you asked but we are just duplicating each other's work, wasting time and using resources that could better be used for say that patient that is having an MI or the new admit. And this is all so that maybe you will get your surgical clearance a bit earlier from one of the services. Not cool.

Consults for medical management help. Unless you have actually tried all of the evidence based medicine guidelines for managing said problem and are actually asking for help because the patient is especially complicated please don't consult cardiology for every CHF patient on hospital day 1 that may need more medication. The attending cardiologist will not give you firm medication recs. if you haven't at least tried for 24-48 hours, so why bother to ask?


And in other news... I am thinking of changing blog names and sites. My island days are behind me and residency is around the corner. But if anyone has particular SGU questions or would like a final post or two before I do so, let me know.

I'm off to Houston tonight to hopefully secure an apartment and tour my new city. So that is exciting.

Only 10 more days of medical school left!
Happy Friday!

"I get to be a doctor!" and catharsis

I think it is finally starting to sink in... And I am SO excited. Happy. Relieved. Thrilled to be done with applications. Secure, finally knowing what I am going to do for the next five years. Over the moon to say that I am going to be a Child Neurologist. All of it.

I am going to be a Texan and while I am still not sure what to think of that part, it does not matter because in five weeks I finish medical school and in just than two months I start residency. And that makes it ALL worth it. I am not saying that it was easy or that the hard work is over, but I am going to be a doctor and for that I am grateful, appreciative and humbled...

But for those who ever doubted me I have a few words.

Dear Dean Z,
You were my first doubter and hater. You promised me/us: the pre-med class of Freshmen, that only one out of ten would enter medical school and that we should just give up before we even took organic chemistry. You convinced many a classmate that she should enter law school, find another major or simply do anything else, yet you didn't convince me. You did however make is seem like going abroad for a semester or taking a science lab course over the summer would seal my fate of not being a competitive applicant. I am sorry I listened to you...  I did not go abroad because of you.... I regret that now because it wouldn't have made a difference, I would still be here today and would have had an awesome life experience in the meanwhile. But I didn't know that then. However, today I am here as a matched medical student and all your doom and gloom  didn't stop me. Sure I cried leaving the pre-med office more times than not, but I made it despite your prophecies. What you didn't know is that you cannot squelch true passion and that now matter how many times you told me I would not make it, I was not hearing your words.

Dear Biology Professor and Student Advisor,
You told me that a Child Psychiatrist was overqualified to talk to children. I didn't believe you then and I still don't believe you now. You were a horrible student counselor and I am glad I left your office and never went back.

Dear Physiology Professor,
I came to your office to discuss my grade and standing in your class. You asked me what my plan B was. I told you I had none. You didn't think this was smart and so I thought about your question and tried to come up with a plan B, but the thing is, I really didn't have the heart to do anything else and luckily I didn't have to. Sure my Plan A took a few more years to achieve than I had originally planned but I met my husband, lived in NYC and grew up a bit in the process, I have no regrets and no plan B!

Dear Child Neurology Interviewer,
You asked me how as an IMG I expected to match. And maybe you were trying to protect me or nicely say that I was not a competitive applicant... but yet you were interviewing me, so why was that? You also asked me who in my family was a physician and clearly didn't like my answer. Maybe you only want residents of physician families and groomed US Medical Student graduates but that is okay, because I don't want to be a part of such a program and that is why I ranked your program last. I guess it is lucky for both of us that I matched elsewhere. You are welcome!

sunny in california with random thoughts of life and pics of my cute puppy

i feel guilty that i can wear a sundress and walk with sancho under a blue sky while the eastern seaboard floods as sandy approaches...

i'm enjoying being home with dr. boyfriend... it is so nice to have time to read, cook, bake, go on walks and just enjoy life. i'm still giddy from interview A. my thank you's have all been sent and now i just wait and count the days until my next interview.

yesterday we carved our pumpkins, which is always one of my favorite fall things to do.

my dog likes to sleep in the strangest positions. case in point!

it is so strange, because 5 months ago i wouldn't have considered myself a dog person but dr. boyfriend really wanted one and i felt guilty that i was leaving him yet again so i gave in... and now i can't imagine life without him. he requires a routine, you have to wake up in the morning, even if you'd rather sleep in. he requires walks and exercise. he won't let you ignore him for too long and he is the sweetest and most stubborn puppy ever. he has never destroyed a single shoe or anything of "ours" but he does a number on his toys. he sleeps in his own bed and can potty on command. he is cute and doesn't mind being dressed up or paraded around. he is a good dog. unfortunately he is is part pit bull and thus often misunderstood and may prevent us from living is certain places but we think he is worth it.

i'm super excited and a little scared to start my NICU rotation next week.

i'm a bit nervous about my dad's upcoming mitral valve repair but glad that i'll be able to be there for the surgery and his immediate post-op period.

and right now i'm just thinking of friends and family in NY and surrounding areas. be safe everyone!

This I Know...

I DO want to be physician.  I chose this career, or it chose me?  Either way, I'm doing it.

But sometimes, just sometimes the path is long and wandering and so I start to wonder... not is it worth it exactly, because I believe it is, or I wouldn't be doing this, but sometimes I pause. I guess what I'm trying to say is that I see friends who have families already (kids, careers, homes) and I wonder if what I'm sacrificing is what I truly want. I see young athletes at the height of their careers and can't help but think that they are going to retire before I even get to "practice" my profession. The path is long and the sacrifices great. I think they are worth it, I know they are worth it. But sometimes, just sometimes I wonder what if I had taken a job teaching first grade or actually traveled around the world after college instead of getting on the MCAT/pre-med train if I wouldn't be just a happy as I am today.

I have no regrets. I don't. I fully understand that I chose this life, I CHOOSE this life and in the end it will be worth it for me. And don't feel bad for me in the day-to-day. Sure medical school is "hard" but really what in life isn't hard? And what I get to do and the people I get to meet, those are things that I do not take lightly. I love my life and I love medical school (well now, maybe not so much in Terms 1-3) but overall medical school is an amazing time. I got to live in Grenada and meet some really good friends. I get to see illness and pathology and health up close every day. I have to travel a bit but that just means I get to see a variety of hospitals and different patient populations. I am away from Dr. Boyfriend but I am lucky I have a husband that is so supportive and that we have a strong marriage so that this is possible. So I don't ever regret going to medical school or choosing this life. But still I wonder what might have been....

And yes, I'm know residency will be fine. It will be hard and long and I'll sacrifice some more along the way but that is what being a doctor entails and I signed up well aware of these facts.

I suppose some of my "pause" comes from the fact that Dr. Boyfriend is about to start the last year of his fellowship thus his journey is almost over. I've experienced residency and two years of fellowship vicariously so I almost feel like I should be done too. But I haven't even started. And I don't even have a residency yet. Or a personal statement written to apply. Or all my letters of recommendation completed. So here I am, about to start fourth year and I have a LOT to do.

And right now I'm in the middle of studying for Step 2 (test date is just 10 days away) and Dr. Boyfriend is out of town at a conference so I'm alone with my books and so maybe that is making me morose. Reflective. Pondering. Whatever.

But this I know....

I am lucky. I do want to be a physician. It is/will be worth it. This I know! (along with lots of random medical knowledge, some actually important and plenty of arcane facts that I'm sure I will promptly forget as soon as I take Step 2.)

missing you

I don't know if its the ho-hum of rotations (8 weeks into IM) or the fact that I'm away from truly good friends for so long but I've been missing Grenada lately. I miss the warm breeze and the chance to go swimming in clear blue 80 degree water. I miss my friends on Friday nights when we would chat over a bottle of wine about our week and our plans after Grenada. I miss the study breaks and the ability to go kayaking on a random Tuesday morning before class. I miss the island time lifestyle and all the awesome Grenadian people. I miss Prickly Bay Pizza and I miss my path group. I've taken to wearing my Path Group NOS scrub tops to the hospital lately... I just miss it all.

I don't miss being an MS I or MS II (being and MS III, almost IV is much better) but I do miss the people and island and good times.

I randomly started talking to one of my favorite clinical assistants at the hospital yesterday. He was born in Mexico City and was telling me how beautiful his home country is and how I should go on vacation there... (and I'm sure he is right) but all I could think was, I'd rather go back to Grenada!

I do like California and where I am and what I'm doing. But it would be super nice to be sitting on the beach looking at St. George's with a good friend calling me to join her for a swim in the warm, sun-kissed aqua water....

Happy Friday!

Ode to an Attending

Get curious! This is what Dr. M would write on a sign which she would then display and point to, each and every time she asked a question re: your pt that you couldn't answer. And there was always a question. During the middle of your presentation it seemed nit picky that she would want to know if your pt's knee Sx from 18 years ago required hardware since you had no plans for your pt to get an MRI and her knee hx was in no way relevant to her CC of SOB or HPI... But the point was, Dr.M wanted YOU to know. Ditto for alcohol drink of choice, where your pt was born, what motivates your pt, LMP, current Hep C status and so on. Dr. M would say, "I am interested in all of your pts and their problems and want to hear about whatever you want talk about." And the thing was, she WAS interested and although she had already looked at the labs and read the PT report and seen the CXR she still let you fumble through your presentation, because that's how you learn and because she knows you need the practice. Dr.M would spend 45 mins to discuss the case of a pt in a vegetative state. A patient that had no chance of ever improving. But she wanted the team to help the patients family prepare for his eventual demise and she wanted everyone involved to feel comfortable with end of life issues. Dr. M would tell you exactly what you were doing wrong but she would also tell you when you did a good job, and you just had to accept that the ratio was closer to 10:1 than 1:1. Dr. M would answer her own questions and order consults when she already knew the answer. But she also admitted when she had her facts mixed up. Dr. M made you aspire to be better, and in the end, isn't that the point?

In case you were wondering...

IM is a little more than half over and most days I still like going to work. I may not want to go into adult medicine but somehow I manage to connect with my patients, even if they are 1. homeless,  2. suffer from mental illness 3. are sadly addicted to alcohol + street drugs + cigarettes +/- pain killers  or 4. all of the above. The patient population is definitely "challenging" and the adults often act like kids but the medicine and pathology is amazing. I heart my preceptor and had a great month with an attending that may pick apart every single thing you say but only because she cares about her patients and wants you to become a good and capable doctor. So how can I complain about that?

All in all, I can hardly believe that 3rd year will be OVER in less than 7 weeks. I am a bit anxious about next year and matching and everyone I still need to do: Step 2 CK, CS, personal statement, ERAS, interviews. I am saddened by my upper SGU classmates that did not match this year but am so happy and proud of those that did. I wish I could fast forward and be there already but at the same time I genuinely LIKE being a medical student and wouldn't mind staying right here for awhile longer. I have so much still to learn, I wish time would be slow down and speed up simultaneously.

Most of all I try to be thankful for where I am in life. I am truly blessed that I get to do what I want with my life. Medical school is hard, but it is also very rewarding and I wouldn't change a thing...

no words

I never considered myself as having a problem with words. I love to write, and it has always seemed to come easily for me. But then I get to IM and my H&Ps seem on the skimpy side. For someone who was regularly told her emails were too long and that the essay only needed to be 500 words not 2000 this is an odd place to find myself. I should be able to write paragraphs about my differential diagnosis but I tend to focus on the most likely and leave out the obvious details because I think they are obvious, or written two sentences above in the labs, or I just talked about it in the HPI but I guess repetition is okay if it is important. I think I'm just modeling what I've read but just because your resident does it doesn't make it right. So I'm working on this. Also, I don't know if I just have an extra attentive Attending or if my pronunciations have been awful lately but I've been corrected when I say words too.
Random examples:
-Rhales is British so the a is an ah not a hard a.
-Triamcinolone (antibiotic) in my head has an extra syllable. And why is this called tack cream? I really don't get it.
-Petechiea (the ch is pronounced as k not a ch)

So I vow to be more thorough, more verbose and work on my pronunciations. And maybe learn some medicine while I'm at it.

I was reflecting on the patient's I've seen so far and I think I've hit all the major organ systems.
Here is the short list:
HTN (only essential)
CHF (right and left sided)
Valvular Heart Disease
Afib vs Aflutter
CAD r/o ACS
COPD
Asthma
Pneumonia
Renal Failure (acute and chronic)
Liver Cirrhosis
Hepatitis (Hep C, Viral, Tylenol OD)
Stroke
Alzheimer's
DM (but all type II so far)
Psoriasis
Reynaud's Syndrome
Panic Disorder
Depression
Bipolar Disorder
Substance Abuse (cocaine, alcohol, narcotics)

Not bad for one month into IM... I wonder what I'll see today? Whatever it is, I'll try to use my words.

*On an completely unrelated note- Happy Match Week to my SGU colleagues and other MS IVs that are anxiously waiting for Friday. Here is a link to the list. Right now it only has pre-matched students but the Canadians will be added soon and then everyone else on Friday or as soon as SGU updates it... Fingers crossed for everyone. I feel nervous this year, I can't even imagine the suspense of next year.

the zebra that wasn't

what if your patient has the worst diagnosis. not because it is something rare and horrible but just because it is.  my patient from day one of IM is still in the hospital and if he's lucky he'll leave tomorrow but still... he walked into the hospital and although he'll walk out his life has drastically changed. i'm sad for him. sad for his family. i was there. he was my first H&P of IM. i won't forgot him... he taught me not just about medicine but about being there. and about how the nicest patient's have the worst diagnosis.

IM is a quarter over which is kind of amazing. tomorrow is the last day with my resident and she's taught me a lot. i've gotten to work with three different attendings and they all had different styles. i've seen a variety of patients. mostly the basics but some interesting cases too.

i'm feeling reflective but its a good feeling. third year is winding down and mostly i feel like i still have so much to learn. but every day i hope i'm making progress.

I'm not taking this for granted

"This" being medicine.

"This" being a chance to be a medical student. Which if you really think about it, is a pretty awesome job. I get to spend my days learning about things I find interesting. I'm on my feet, talking to patients and practicing skills I hope to spend the rest of my life doing. I am not really responsible for anything. Nothing is expected of me beyond being interested and showing up.

"This" being a part of patients' lives when they are at their most vulnerable. As a medical student I have time so I can spend an hour talking to and educating my patient about whatever disease and treatment is relevant. I have time so I can talk about life or anything really... and I like this time.

I can spend half the day in the library reading. Or I can spend it in the cath lab, or GI suite or wherever else my patient may need to go. I get to see medicine from the perspective of someone who knows a little but has the time to absorb it all.

I'm only 10 days in but so far I've see the textbook come to life.
Ascites with a fluid wave. Gout with tophus nodules. Stephenson-Johnson Syndrome. Hypertensive retinopathy complete with arteriovenous nicking, cotton-wool spots and flame-shaped hemorrhages.

This is medicine and this is me getting to do it.

I love this time in medical school. Third year is nearly over and I'm just happy to be here. This is good.

"for the dead and the living, we must bear witness." — Elie Wiesel

Today a patient died. I met him in the ER just five short days ago. At that time he was talking, breathing, living. But then he got sick.Very sick. And surgery and medicine and a stay in the ICU could not fix his failing organs or return him to health. His family watched in disbelief as each day he got sicker and sicker... And today they had to say goodbye.

As a doctor in training I am privileged to be with patients all stages of life and sometimes even death. Today is a day to remember and as such I am reflecting on all the patients that I have met whose lives I glimpsed before they were over. I will remember... the smiles, the jokes, the lives of my patients. 

I will remember them because to remember is to bear witness, and this is something I can do.

---

This day in September, ten years ago started normally enough for most people. Preparing for work, boarding a plane, going about their day to day business... no one knew what unimaginable things the day would bring. I was in Boston at college, in class and not privy to the first tower being hit.... but as the news started to make its way around campus and throughout the world my would be husband came to meet me and as class ended I walked out to see him standing in the hall, waiting and in the instant I saw him,  I knew. 

I didn't loose a family member and I only vaguely knew people affected by the attacks, at least at that time.... However we later moved to NYC and then I met countless people who had been there, witnessed the towers falling, walked over a bridge to safety or fled the city afterwards. I know families that decided they could no longer live in NYC and I know people who never-not in a million years- considered leaving. 

New Yorkers have solidarity when it comes to 9/11. So today I partially feel like I'm on the wrong coast. 

People still talk, people still remember, but the events are not quite so raw, not quite so close to home... Of course those that lost their lives on 9/11 were not all New Yorkers. And really it doesn't matter where one is today or where one was ten year ago. What matters is that we remember for those affected by 9/11 and especially for those who lost their lives.

It has been a decade, but we still remember. It is one thing we can do.

Revelations!

So, I'm only two day into my Family Med* rotation so I'm not sure if that is really enough time to come to any conclusions. But I'm going to anyhow because I have the time to blog and because in just two days time I've come to realize a few things about myself... First a quick comparison, which is probably not fair to either field but its my blog and I'll compare if I want to!

Going from Surgery to Fam Med feels like running a marathon to strolling in the park. Everything moves a whole. lot. slower. Everyone is nice. The attending bakes you homemade chocolate chip cookies (literally), the resident apologizes for not having time to teach and for being so busy. You are asked repeatedly each day if you need to eat and then given ample time to do so. All patients are seen by the attending, every day! It is like an alternate universe. And I'm not sure what to make of it.

All of this is good. And nice. But it kind of bores me. In two days I've only gotten a single patient to myself. I did help another student with her H&P and co-wrote a single note this morning. Plus I got the priviledge (a.k.a. intern too busy so asks me to do it) of updating our team's entire patient census list which was grand total of 6 patients. But back when I was a surgery student I saw 6 patients/ wrote 6 notes in a single morning.

Okay, so my patient. I did his admission H&P on Monday and today I got to present him to the attending and help her with the A/P so he's mine until discharge.  Except that not tomorrow morning because our team switches to night float for two nights so another team covers our patients (I don't know how that makes any sense but that is how it is). Anyhow, maybe by the end of the week I'll have two whole patients. That's the hope anyhow.

Oh, so my discoveries. Well while we were busy waiting for rounds to start, then later munching down chocolate chip cookies, then later at lunch, then later waiting for rounds to resume and then end, I realized that I did not like that attending had to run off to deliver a baby in the middle of my presentation. Or that the 11am weekly lecture was canceled because of the same. I know, it is medicine and things happen. But I think I need a schedule, a plan. I don't get stressed when plans change per se. I'm okay improvising or adjusting but I do like having structure. And surgery had that going for it. Cases were scheduled. When one finished another started. There was some predictability of what days were clinic versus OR versus just rounds.

Family Med is the embodiment of unpredictability. In the next six weeks I never get more than one day off at a time. My schedule changes every week.  Actually it changes ever day or two. As a medical student on a rotation this is not a big deal. But I cannot imagine a life of this. So I guess that means inpatient Family Med is off my list... which is too bad because the people are SO nice. Maybe it is the laid back nature and the I can deal with anything, at any time mentality that makes these people so cool. So I hope that they can be my friends.  But I guess I'm too uptight for their field.  Surgery vs Medicine: It is the classic do versus think. And come to think of it, I've always imagined myself somewhere in the middle. Child Neurology is a middle ground, right?

*Disclaimer, at my hospital the Family Med rotation is all inpatient so it is really more like an IM elective and probably not wholly reflective of FM


** This post is not to slight either Surgery or Family Med. I met some brilliant surgeons that were quite capable of thinking and even treating the whole patient. I learned a lot of medicine from my attendings during surgery. And it is important that we have people who love Family Med and do it all, it is SO needed.  I just don't think I'm one of them.

Three Months Later

Patients seen: 88
Surgeries scrubbed into: 26
Lives lost: 7
Goodbyes said: 1
Hands held: 15

Surgery is over and I don't think I'll miss the ER/traumas or sad stories that bring the patients to the hospital. I'd rather not have to contemplate skin grafts for the women who fell asleep while smoking causing her bed to catch on fire and burn 30% of her body. Neither cup of noodles nor sparklers should never be given to children to children under 7. Gas stoves or BBQs and unsupervised cooking for children- please no. And just in case you didn't know: grandma driving while on amphetamines,  uncovered empty pools without water, holding a boiling pot of beans in your lap = very bad ideas. I use to think hang-gliding sounded like fun, but after seeing the results of landings that didn't quite work out maybe I'll rethink that. I have had my fill of gun shot wounds and stabbings. Pneumothorax, appendicitis, cholelithiasis - check, check, check!

The OR was actually quite fun most of the time. I can see the appeal, and I even liked about half of the surgeons I met. I'm crossing surgery off my list but am so thankful for the long rotation (even if I wasn't always thrilled during it.) I will probably never see brain surgery or even a lap appy again, but I'm so glad I got to experience them.

(Next time I post I'll be on inpatient family med. Stay tuned.)

Grenada Goodbyes with 2 Days To Go...

I  thought this post would be easier to write. I'm done. No more medical school in Grenada. In just two days I fly home. Basic Sciences are over and this chapter of my life is closed. It seems both triumphantly amazing and like a big let down simultaneously. 

Since Thursday there have been parties and more parties, several trips to the beach, a drive around the island and sailing trip to another island. I'm not bolting from Grenada but rather making the rounds and saying my goodbyes.

It wouldn't be a pictorial countdown without a picture or more, so... 

The Shadowfax catamaron sail boat that took us around Grenda and to Hog Island. My third time going, love it!

 Christmas spirit in Grenada. Did I mention I heart X-mas lights?

Belmont Estate and Chocolate Factory. Beautiful plantation and they do a nice lunch if you find yourself on the North side of island. If in doubt, go! (Its worth the trip.)

Reflections of 2009 - A Blog Review

As per Srav's reminder and instructions- Take the first line(s) of your first blog entry of each month and presto:

Well, I'm not exactly ready to go. The problem is my bags are OVER packed. 


So, I cannot sleep again... I don't know if it was the 2 hour nap after lecture (thank you migraine and Relpax for that!), the cup of coffee at 8pm or the fact that I'm feeling a little guilty for the amount (or lack thereof) of studying I accomplished today but here it is, after 2am and I am wide awake. 


I know I haven't posted lately, and I'm sorry... I'm going to use the excuse of midterms. That and I'm on island time... 


[Somewhere Over the Rainbow...]...blue birds fly? Maybe but not in Grenada. Instead we've got cows, geckos and toads!



My grandmother just passed away. I have been wearing her pearl earrings since I learned that she decided to leave the hospital on Tuesday. 


Term One ended. I did finish all four books and Fox's memoir is worth the read.


If you are in medicine then you  know that July 1st means the new residents have started working. 


I am back! I made it despite a bit of a layover in Trinidad and now that I am here I'm feeling quite unmotivated... maybe I did a little too much this summer, but I still have a few days before classes begin to sleep in, get settled, enjoy Spicemas, go to the beach, etc. so it should be okay.


So, one of my goals for term 2 was to attend a health fair. And I went to my first today. It was amazing. 


[Happy. Lucky. Loved.] Just a few words to describe my mood at the moment.


So, I did it. I went on my first Hash. 


There is nothing left to do but study.

So, that pretty much sums up year one of medical school and 2009. Other stuff that didn't make the blog but are also important and worth noting... I celebrated my one year anniversary to the love of my life (my constant support and the person I cannot imagine being without.) My classmates are some amazing people and among them I made new friends for life. I was reminded of how lucky I am to have such a wonderful loving and supportive family. Going to medical school in another country is hard. But medicine is not an easy field and if anything SGU and Grenada have prepared me for whatever may come my way. I survived year one of medical school and have no regrets, so no looking back- Happy New Year and Welcome 2010! Wishing my readers and everyone the best this coming year.