it's a brave new world

MS1 of the class of 2019. Stories about my journey through medical school and my career in medicine, from my acceptance and beyond.

[sliceofmedicine]

Hey folks. It’s been a long time. I’m glad to say I made it through M1, but I can’t feel like I can say the same for M2.

We’re two (almost three) weeks in and I’m already exhausted??? I feel this huge pressure to succeed, and there’s so much information, and now with the looming horror of Step 1 I feel really overwhelmed. I’m reaching out to my school’s mental health resources, but I also want to reach out to you guys, my fellow medblrs. I thought I knew the answers, but this year has made it apparent that I don’t: how do you guys deal with burnout and anxiety, and how do you balance the monster of med school with your own wellness?

[sliceofmedicine]

Sorry for the extended absence all. Second semester was and still is kicking my butt, but with my new and improved study schedule I’m starting to hit right back. Just goes to show that you can’t sit still in medical school. Never get too comfortable. It’s a changing environment.

Also, neuro is a lot easier thanks to the Rule of Four. God bless you, Dr. Peter Gates.

[sliceofmedicine]

It’s kind of ridiculous how much jargon is involved in anatomy? And it gets worse when you find out that physiologists and histologists and every -ologist out there has a different word for the same thing. Science, why you gotta be like this.

[sliceofmedicine]

Pro-tip: short fingernails when conducting a physical exam is a must! My apologies to the standardized patient who was mauled by my talons when I was palpating his abdomen.

[sliceofmedicine]

tfw you offer to lie down on the floor of the anatomy lab in order to provide a height comparison to your cadaver

[sliceofmedicine]

I cannot wait until we get to our micro unit. We were talking about retroviruses briefly in the context of gene therapy and I was already happily sighing.

[thrillervevo]

[sliceofmedicine]

In my doctoring class we were advised to avoid this situation by all means possible. These questions are important, and the presence of parents or significant others can impede in obtaining a thorough and honest history. Students and docs, it’s our job to make sure our patients feel comfortable answering our questions, and that includes giving them an environment of safety and confidentiality if you can! Ask parents and others to step out of the room, either at the beginning of the interview or at least before these questions are asked.

[sliceofmedicine]

That feel of horror when you think you’re the first one out of the OSCE followed but that feel of relief when they tell you that you’re actually not

[md-admissions]

I don't mean this in any rude way (but because I have no knowledge about what being on life support implies go for the patient) but how does being on life support include the possibility of dying without dignity?

Not rude at all. This is a VERY good question, because most people honestly don’t know. And I’m incredibly happy that you asked!

I going to explain in the most straightforward way possible, the way I tell patients and their families. 

So, being on life support is not gentle, nor is it comfortable. Being on life support requires machines becoming part of your life. 

Let’s focus on intubation. Your breathes are controlled by a machine, via a hard, plastic tube that must be placed down your throat. Plastic isn’t meant to stick in your throat. So it causes inflammation, irritation of your throat. People who get actually get extubated will tell you, it is VERY uncomfortable, even with the sedation and pain medication provided. Intubation also carries it’s own risks. It puts you at risk of pneumonia, lung damage, and if placed for too long, your muscles weaken because you are not exercising them to help take your own breathes. 

Okay, let’s now talk about the connection of dying with dignity.

I first want to say there is nothing inherently wrong with life support technology. For those who have diseases or trauma that have a high chance of recovery, the employment of this technology is only temporary. They help make recovery possible. The frequent poking of needles to insert catheters, the constant suctioning of sputum from one’s mouth, are worth it because the good (recovering and going back to your normal or near-normal self) outweigh the bad that the technology causes. The only time these life supports’ good do not outweigh the bad is when a patient does not have a good chance at recovering a meaningful life after all of these interventions are through.

Imagine yourself in your loved one’s position. You are already very ill and weak, that is why you are in an ICU. So you already feel poorly. Being on a ventilator also means being sedated, because it IS so uncomfortable. So imagine yourself, in and out of a state of wooziness, with this hard plastic tube in your mouth, with at minimum your wrists restrained in soft foam cuffs, to protect yourself from you; in case you flip out and try to yank the tube out of your mouth (this is very common, because the tube is uncomfortable!) You can’t eat, not regular food. Nutrition is usually deliver as a liquid through a tube place down your mouth into your stomach, or through a drip into your veins. You must urinate through either a Foley catheter or in a diaper. 

When these machines and all of these complications and invasions, when this becomes your life and becomes a permanent fixture of the patient’s survival, this is where patient input and patient’s family input is incredibly important. All of these interventions: sedation, intubation, restraints, foley catheters, nutrition through tube feeds, just being in a hospital with other people who are ill, carries risk. 

We need you to help tell us what you think is a meaningful, fulfilling life. If life isn’t worth living if you can’t eat solid food, I want to know. If life isn’t worth living if you can never take a walk with your own two feet again, I want to know. I NEED to know. Back to my original post #202 regarding the angry cousin: he was mad at me because he thought I was telling them to decide if she lived or died. That is not what I’m asking. I’m asking about WHAT LIFE MEANS TO THE PATIENT. Because if you can still find meaning in life, bed-bound, sedated, intubated, restrained for your protection, etc. I NEED TO KNOW. If you don’t think so, tell me. I don’t want to cause harm, I don’t want to keep you from living or dying on your terms. Tell me what harm means to you, or what harm means to your loved one. Tell me what they think it means to live, what they think a good death is. If you love your loved one, you also don’t want them to be in prolonged pain that has minimal results. You want to respect their decision, honor their wishes.

So that is why it’s not the technology that subverts dying with dignity. It’s the notion that prolonging physiologic signs we call life is the equivalent of living.

[sliceofmedicine]

If you can take an elective on grieving, physician burnout, or mindfulness, you definitely should! I had no idea what my experience was going to be like, going into the one at my school, but I’m very glad I took it.

[attackonstudying-deactivated201]

There is no shame in starting off as a beginner.

attackonstudying (via attackonstudying)

[sliceofmedicine]

a naive B cell is like a teenager coming into their sexuality. it has all the equipment and none of the experience.

immunology discussion leader

[wishbone-md]

Long time no see

I really should start making time to write on here more. My life has consisted with school, boyfriend, small social life, and sports. It doesn’t help that my boyfriend is in my class, I drink with my classmates, and I play intramurals with other med students. Medicine, medicine, medicine, all the time.

Sometimes I feel like I’m losing myself a little bit. I haven’t been writing much because I don’t know what to write. If someone were to ask me to tell them about myself, my answer would be “I’m wishbone-md and I’m a first year.” That’s it. What I’m going through doesn’t really make sense unless you’ve been through it yourself. I have non med friends that I occasionally see but they don’t have similar burdens weighing them down. I’ll try my best to write about these anchors more often because lord knows I need some catharsis.

We’re doing microbiology in class right now. I love that we’re actually doing diseases now as opposed to biochem and cell bio at the beginning of the year. Case studies are my jam, now that we’re talking meds and everything. I had a very rough start of the year because I would just avoid doing work since it seemed like everyone else was doing SO AMAZING and that people already took these classes. Avoidance is unfortunately my coping mechanism. I almost did not pass the module because I felt so bad about myself for a long time. But I’m doing better now because I like the stuff we’re doing and I’m getting more confident. It helps that we are moving into territory that classmates haven’t had in undergrad. I continue to hate rote memorization but it’s something I’m starting to accept as a necessary evil. I’ve gotta do it or I’ll perish and never match. Currently feeling out Firecracker and I bought Pathoma but I haven’t watched any of the videos yet. We’re gonna be tested on myeloid and lymphoid neoplasias soon. 

I’ll be out here grinding in the corner of a tiny Starbucks.

[sliceofmedicine]

Avoidance is something I definitely had to grapple with last block too. I hope you find a way through it that works for you!

[hownottoloseyourmind]

But I guess I came over here to tell you how proud of you I am. Not because you did the best you could for those patients, but because after twenty years of being a doctor, when things go badly you still take it this hard. And I gotta tell you, that’s the kind of doctor I want to be.

J.D. on Scrubs to Dr. Cox after his breakdown

(Me too, J.D.)

[sliceofmedicine]

Non-study study tips:

Sometimes the most important part of studying is what you do when you’re not studying. Here are some things that I’ve learned during the past few months as a M1 that really work for me.

Save the caffeine for when you really need it. Yeah it might be hard to get out of bed on a weekday, but you’ll be grateful when it’s a late night of studying and the coffee you’re downing is truly pulling its weight.

Get some sleep. Of course I would recommend at least 8 hours in an ideal situation, but I don’t even get that amount of sleep during review week. I usually try to aim for at least 6 hours though, because that’s the amount I know I need. Find the amount of sleep that works for you; at least a few hours of shut eye can really do some good.

Take care of daily hygiene and meals. It may seem like the minutes it takes to shower could be better spent memorizing the TCA cycle, but when you feel clean and put together it just makes everything else fall in place too. I always feel better when I’ve showered and eaten.

Don’t just sit for hours upon hours. Give your booty a break! I study using the Pomodoro method, and every time I hit my 5 minute break period I get up, walk around, refill my water bottle, go to the bathroom, anything to get on my feet.

If you’ve got any more study tips, let me know or feel to add them below!

[sliceofmedicine]

Every time I get really stressed out about things (which is usually exam time, aka now-ish), I remember that medical school is asking a lot of its students. I’m getting a lot of information, in substantial amount of detail and depth, over a short period of time, and it’s okay to be a bit flustered by all of that.

[sliceofmedicine]

What dont you like about your school?

Yeeesss anon, you’re asking the good questions. ;) Now this answer is not going to be as useful as asking a student of a school you’re actually interested in because 1) I’m just a face on the internet and 2) you have no idea where I go to school and I will certainly not be sharing, but I can give you a few examples.

The fairly homogeneous patient population. I lived in the city of my medical school for a significant amount of time and knew this going in, but that doesn’t mean I have to like it. Thankfully there are still opportunities at my school to work with racially/ethnically diverse, underserved communities, but it just takes a little more work.

The structure of one of my classes. Now I can handle variable quality of professors, but the actual setup and resources for this class is just not at the same level as other classes. You can tell which courses have been finely honed over time and which ones less so. Unfortunate but true.

Logistical things about facilities, e.g. limited natural lighting, limited to no parking. When you realize that you’re getting a quality education no matter where you go, the small things seem to pop out. Having a nice study spot or the convenience of a short/good commute are those little icings on the cake.