Friday, October 31, 2008

The Ups and Downs...

Rotations, at least for me are so love-hate. Some times of the day you are just soooo excited and others you can't WAIT to get out of the hospital. It is so back and forth sometimes, it becomes mentally draining. I am now half done with my OB/GYN rotation and surely think this is a rotation I will miss. It has been more than busy and always keeping me moving! My last call is this Sunday from 8am until midnight, which I have beeen dreading but since it is my last one - it's best just to push through it and be done. Next up is ENT 4th year elective! That's right! My dear, dear friend Anna is a miracle worker and is the only reason I got such an opportunity - I LOVE YOU! I will be doing two week of ENT from December 1st-12th (perfectly fitting between Thanksgiving and Christmas, wink wink. Doing this really will help in the end when I wished I took the extra time I had an used it do finish off some weeks of elective rotations - might as well start now. I figure the sooner I start chippin' away at 4th year (sounds weird to say that!) the sooner my Tony and I can go on our honeymoon!!! So much to do, oy. That being said, I thought it would be fun to try to explain just some my ups and downers of clinical years thus far - ENJOY!

Upper: being an "upper classman" in the medical school world.

Downer: more responsibility and can't just a take a day off or sleep in because you feel like it, ah the joys of years one and two!

Upper: In OB particulary, doing one of your first SVEs (sterile vaginal examination) and having your attending agree with you on your assessment of the cervix! 1/50%/-3 (means 1cm dilated, 50% effacement or thickness/length of the cervix to palpation (which an actual measurement might be nice to get as well) and -3 means the baby is still wayyyyy up there and not yet decended - see you can learn from me too!)

Downer: actually a literal one is passing out in the OR... Yes, it happened to me this past Thursday and it was mighty embarrassing but very funny now. I was supporting the uterus in a laproscopic procedure - long story short - big OR light on the back of my head for over an hour + little to no food in my system + sweats + rebreathing my own CO2 with hyperventilating = BAM. Luckily I didn't contaminate anything but myself and I got a cookie out of the deal! God bless the nurses and scrub techs! :)

Upper: the feeling you get after participating in a case, be it retracting for the first time or later being allowed to even do part of the actual procedure! On my first GYN surgery I was able to make the first incision on a hysterectomy case (mighty straight I might add, lol) have been able to deliver the placenta, do countless SVEs and speculum exams, abdominal stapling, yes retraction (woo., haha), even two days ago was able to use the curette in a D&C and work with the hysterscope, ultrasound and anatomy scans and much much more. Oh yeah, can't forget those lovely H&Ps.

Downer: the constant (constant) stress of trying to impress people, be it by bringing up the right questions and not just dumb ones, getting questions right (big one) asking "Would you like me to do that H&P for you?" (when in your head you are like - say no, say no!!!! hahaha) or truthfully just staying awake.

Upper: still being a student where making mistakes (albeit gross ones) are generally allowed. This is the time to get things wrong so you will remember it later and have it forever ingrained in you to do it right from then on!

Anyhoo - just a few of the ups and downs I have come across... I'm sure there will be more to mention as time goes on, but as for now - it is time to get some rest! Goodnight!!!

Monday, October 20, 2008

Still here - and trying to hold on...

Things are slowly getting better but it is really still day to day for me. Luckly, one week of OB/GYN down and things are going very, very well. I really didn't think I would, but I have taken quite a liking to this specialty. This rotation begins with two weeks of clinic, then two weeks of GYN surgery, then 2 weeks of OB L&D (labor and delivery). This week now is the last week of my clinic days and I am shocked how fast it went by. I still have 3.5 days left but I can't believe how much I have learned in this short of time. I definitely feel that my money is being well spent on this rotation. The days are long, most days being 6am-5pm but with so much to do and learn, it flies. I have done quite a bit of speculum exam, which I am getting more comfortable with now. It is so odd but for some reason the cervix just falls into place for me with the plastic spec. The metal ones? Not as good of luck, lol so wierd. Anyhoo, I have gotten to do plenty of those, bimanuals and even have been starting to do ultrasounds and fetal anatomy scans! Even today I had the privilage of being part of telling a patient she was having a boy. It was pretty neat.

We have 4 days of being on-call but they are only until midnight and not an overnight shift, so that is nice. My first night on call was really great. There were two deliveries and of course, both happening at the same time. I was in on a Cesarian section (C/S) when one of my residents (1st year) was paged out of it for another patient's vaginal delivery. With my other resident (3rd year) and the attending were busy delivering the baby and placenta, then beginning to close, I offered to take over for my resident paged out in assisting with the surgery. On my first delivery I was able to retract (cool now but I bet in surgery, 5 hours of that will be annoying haha), cut sutures and even staple the whole abdomen! One thing I really feel is that the OB/GYN staff here at Synergy are really dedicated to teaching. You can just tell that they love to take the time and I appreciate that. My patient is still in the hospital so I round on her everyday after her surgery for morning report at 7am. Residents round at 6:30am so I am sure to round and write my SOAP note before they come around. Then I present a short 10 second summary about her in morning report and once it's over, I head to my morning clinic assignment. Everyday at lunch is lecture then it is off to our afternoon clinic assignment. No time off for the day but when you are learning so much and have such eager faculty, it is hard to complain.

My next call is this Wednesday then it is downhill until the weekend when I get to finally go home. I was unable to go home last weekend due to my call on Friday night (17+ hour day) until midnight, so I was blessed to have Tony come up to see me. I can't say enough how much that meant. It was nice to not have to leave home on Sunday (even though I miss my Mags) as that is just the absolute worst time for me each week. Driving away makes me cry everytime and for the first time I was okay on a Sunday. Last week was probably the worst I have been - even worse than the island and was pretty worrisome but I am trying to take it a day at a time so I don't get back to that place. Looking at the whole road ahead it seems is overwhelming and as much as I want to look to the finish line, I know it is a ways away. I just need to take one mile marker at a time... Sigh. Just hoping I can continue to hold it together...

Anyway, I am going to relax a bit more before turning in. Another day awaits...

Monday, October 13, 2008

Take my hand, Precious Lord...

Psychiatry is now over and it is onto rotation #3 - OB/GYN which started today. I really enjoyed psych and while I don't think I could see it being a speciality I would do alone, I could see it in conjuntion with another specialty, like oncology to deal with both the medical and mental afflictions affiliated with being diagnosed with terminal illnesses. My presentation on DID (dissociative identity disorder) went very well and out of the blue our shelf exam was cancelled due to some issues with test delivery. So I was off to go home for a nice long weekend home - and it was fantastic!

Now, starting fresh with this new rotation and what do you know - feeling back in the rut. I was happy last week when I felt the accomplishment of another rotation but feeling at the bottom of another mountain being a new rotation, I find myself exhausted and utterly drained mentally. I'm sure most are sick of hearing my rants about being "down in the dumps" but as always, you chose to read this so it is up to you to read on. I am just having alot of issues with my emotions as of late, same as before yet in a deeper quality. Not to a dangerous point or anything but I have been having doubts as I am sure I have not been the only one. I just feel at the end of my rope lately and feel bad for that fact as I come off as just not that strong lately (which is scary considering I haven't even hit surgery yet). Things are better than before considering, but it almost seems as if being that much closer is a daily tease. Hearing things that are going on with my home, fiance, family, dog - even how the lawn needs to be cut or the laundry needs to be done is wearing at me at how I am just not there and how desperately I want to be so. I'm stricken with guilt too because even my future husband sees that I am not as optimistic and cheerful as I once was which makes me even more sad because even though it is true, I know that is who he fell in love with and I hate not being that person lately.

I've been back from the weekend about one day and have only had breaks from tears enough to get through orientation today. Waking up in the morning, my eyes are just so swollen. I am getting so tired of not feeling like myself to the point where in the back of my mind I have thought of taking a break from all of this. I literally have had feelings of being "stuck" knowing quitting now means a hell of alot of debt and disappointment in myself, who has never been a quitter. Even in signing up for Step 2 CS recently, I paused during submission of my payment, as I was unsure whether I wanted to spend $1200 because of these doubts. But after taking a moment, I know that stopping isn't what I want. Even taking a break means dealing with the rest of my education at some point - and no time like the present right? What kills me even more is that I am good at this. My preceptors have all liked me very much in the past, I truly enjoy the patient contact and being involved in their care. I am just so torn in my mind. I've had thoughts though, that why didn't I become something else in the medical profession? I thought about PA school and if I had pursued that I would be one by now. Why not be a nurse? My mom is the best of the best in that department and she is happy. I'm just back to the elemental question of any med school interview: why do you want to be a doctor?

I've heavily debated posting this. Part of me really thinks I should keep this to myself to save any embarassment or comments that I am not "doctor material". I have to admit that it is nice to vent it off though, even if no one reads it. Everyone is telling me it will get better and that I'm feeling this way because of one reason or the other. I just don't understand why it can't be me? Am I not as susceptible to feeling low like my previous patients? You would think knowing the signs and coping mechanisms I would have been able to talk myself out of this by now and believe me I am trying. To put it in psych terms, I feel like throughout school thus far, I am in a constant Adjustment Disorder by Axis I (little psych humor). I'm up and I'm down inside, repeat and repeat again.

I truly hope that it is just me getting into another rotation and feeling overwhelmed by it. As time goes on I am hoping and betting on the fact that these feelings will subside and only get happier knowing I am going to get to be home until the new year. I hope that my strength comes back and I can act and truly feel that I am coming back into my old self. I hope that God stays with me, picks me up and gives me back that toughness, optimism and joy that I feel has dwindled as of late. ...I hope...

"My precious child, I love you and I would never leave you. During your times of trial and suffering, when you see only one set of footprints, it was then that I carried you." ~Footprints in the Sand