Medschool flashbacks: Step One and Surgery

More flashbacks as I continue to sort through old things. I have rediscovered a journal I kept during medical school. Herein you'll find some of the more memorable entries (for better or worse). Please excuse the weird formatting. Seems cutting and pasting is not Blogger's friend. Hopefully you'll be able to sort out the journal excerpts from the current narrative...

When I was in medical school we had many unpleasant things that were required of us -- terrible things, like our first round of Board Exams, called Step One. I began to call these "rites of passage" or "must-do's" The Flaming Hoops of Death, or, FHOD for short. Step One was by far one of the most challenging FHODs in that it was not only insanely academically challenging but also, if you really think about it, not all that useful for the real world. Really, who remembers (or even needs to remember) all the lysosomal storage diseases by the time we hit the wards?

Studying for Step One, as any medical student can attest to, can drive someone to the brink. Evidence in the below entry:

Tue, Apr. 12th, 2005, 03:26 pm -- Mini freak out:

This test is insanity. They might as well just stick us in a room of rabid raccoons with a disposable razor and tell us to make a fur coat. That might be easier.

For motivation I had a 4" stuffed horse I named Power Pony who would perch at my table where I lived to study and remind me to stay on track (see above photo of my study set-up circa 2005).

Fri, April 15th, 12:39 pm

Power Pony is trying to motivate me. He looks at me with that one cocked ear and those soulful eyes and just begs me to be productive so I can pass step one, go on and be an MD... then have my own stables or at least be able to board at a real jumper facility.

Ah, yes, the motivation: pass this test, get an advanced degree, have a career, buy horse. Certainly the path I thought my life would follow. And, hey, I'll let you more careful readers onto a secret right now, I'm working on the horse thing now. For reals. But since counting chickens only seems to make me look like a turkey (love the fowl metaphors) I'll wait until things are more certain before caw-cawing about it on this blog.

Sat, Apr. 16th, 2005, 11:37 pm -- Positive Thinking

All the studies show positive thinking works.

I will pass this test

I will pass this exam

I will ROCK the boards!

I will be productive the next three days, go over FA again, finish all the QB questions, and ROCK this exam!

Then I will spend a week on an island, drink piña coladas and ride horseback on the beaches.

Then I will get my ass busted on surgery and love every minute of it.

...and then I'll win the lottery (without even buying a ticket) and be able to pay off all my loans and buy an 8-year-old CET-trained jumper and ride him at Spruce :)

hey if i'm going to think positive, i'm going to think BIG :)

After the fun of Step One, I spent 10 glorious days in the Dominican Republic where I did indeed ride on the beach (evidence at left). I came home to a rude awakening. In my naive optimism I held out hope that after two years of classwork, relentless exams and the penultimate memorization leviathan of Step One I'd finally see real, live patients and realize how totally radical medicine was. Unfortunately, I started with surgery. Radical was not an adjective I found myself using. I used more words like exhausted, angry, abused, nauseated, discouraged and mistreated. Honestly, reading in my old journal about the blatant mistreatment of medical students, interns and even patients (both conscious and unconscious), the perpetual self pity and hidden tears behind facemasks and such probably doesn't merit much retelling. It's good to have those entries for posterity (and would make a great modern chapter in an exposé-style House of God-type novel) but it may just make you all feel as sick as I did. I did find this gem of an entry:

Mon, May. 30th, 2005 -- A good memory

I do remember one not bad thing. I was in the OR with Dr. C. and he took the omentum from the patient's abdomen pretending it was an alien and having it snatch his arm. I was so tired and beaten and this was such a light and strange moment I laughed hysterically. I told all my friends about it and how funny that was. I'm sure, though, the patient wouldn't find us playing with her omentum particularly funny. Nonetheless, it was one of the only times I laughed in surgery. Funny, when I do, it's always a desperate hysterical laughter, not real joy.

Funny but sad. My first rotation was colorectal surgery at the Catholic hospital follow by transplant surgery at the University Hospital. Both painful in their own ways but the first month was by far one of the more abusive (and, until my OB/Gyn rotation, I thought was as bad as it got on the wards).

After finally finishing the month with the evil colorectal surgeons I started transplant, and while certainly wasn't nearly as abusive, the hours were doubly challenging. Even though it was dead of summer I had to use my light box to simulate any daylight.

Tue, Jun. 7th, 2005, 05:34 am - Day one of the new rotation

Yesterday was interesting. I was up all night the night before totally sick to my stomach. Didn't feel any better in the morning. Was up at 5 AM to round at 6. Then after rounds, here was my day:

1. Nephrectomy at 7:30 - try not to vomit, I feel sick as hell.

2. Renal txplant at 10:00 - try not to vomit or break the sterile field and cradle my stomach (so tempting)

3: get Purell in eye and have to wear one contact lens at noon - take two bites of a granola bar - my first food of the day.

4. SPI case where i was out of it and uninterested. 12:30-1:30

5. Put contact back in. Still feel ill but try to eat. Not very successfully.

6. Meet more of the team, get "trained" by survival flight.

7. Make call schedule with other med studs. I'm on call every third day this month. Splendid.

8. Get ready for next OR case.

9. Next OR case takes forever to start. Sit and chat with patient getting surgery.

10. Finally, at 5, I go to the OR where they are preparing the pancreas for about an hour.

11. Surgery starts and I want nothing more than to lay on the Mayo and sleep.

12. The surgeon first decides to call me Betsy, then Nancy. Neither are my name. He knows this but thinks it's funny.

13. I get my pimping questions right. He starts using my first name.

14. Get a second wind when the pancreas pinks around 8 PM.

15. Start walking home a little after 9 PM. Feeling guilty for leaving "early" because there are other cases going on that night.

And here I am the next morning. Feeling sick to my stomach as usual (the worst part about surgery, I think). About to start it all again.

And that was just the first day. After that it didn't get much better. There was the day where I was post-call at grand rounds. Sleep-deprived and already feeling ill the topic was total facial reconstruction surgery.

Then we have grand rounds, where, much to my fatigued delight I get the pleasure of seeing people's faces being removed for surgery, their faces cut open down the middle, their jaws split in two and their faces splayed opened like books. It was probably one of the most gruesome things I've seen... more gruesome any autopsy because these patients were alive!

A great way to start a post-call day, eh?
Then there was the day I almost passed out. Note to non-medical folk - it happens to everyone. Even the hardened surgeons. It's nothing to be ashamed of and certainly isn't rare but it still is always embarrassing. My attending, of course, never helped matters.

One day I almost passed out in the OR. The operation was an AV graft (minor procedure). I felt it happening. Before the case I inhaled an egg sandwich from the caf so I know it wasn't low blood sugar - although I wasn't about to admit that to anyone, I'd rather them just have thought it was hypoglycemia.

I sat back on a stool and tried to put my head between my knees when I felt it coming. It didn't make it any better, just kind of held the sickness and fuzzy feeling where it was. The nurses asked if I wanted to go outside to the break room and eat or drink. I reported that it wasn't a good idea for me to stand up. Before I slumped off the stool they grabbed some blankets and rolled them out on the floor and I lowered myself and lay there for a few minutes. The patient, who was awake (as is standard during a procedure like this) asked if I was okay. How humiliating! I felt better quickly after laying flat. I went outside, got some water, and then scrubbed back in as if I never left.

Long term side effect: Dr. M has decided to call me Syncope Sally now.

And of course, the optimism that always tried to sneak out even in the darkest hours...

At the U there is literally a light at the end of the tunnel. As you walk from the main hospital toward the Cancer Center, toward freedom (i.e. The Exit), you approach this sky-lit hallway. It's a beautiful sight - especially post-call. Even with the construction being the view from the hall, and the smell of the coffee stand making you nauseated, it's still the most fabulous part of your day: a little preview of freedom. I reiterate, a literal light at the end of a tunnel. I can hear a choir of angels singing as I pass through to my freedom. Or maybe that's just my ears ringing?

And now, as I wrap up this flashback entry I look at a mailing from University of Michigan Medical School with the incoming class of medical students all posed together, happy, in their sparkling new white coats. It's a solicitation from the Alumni Society, asking for donations. But my reaction to that picture? Poor, poor kids. They have no idea...

Next flashback will perhaps be pediatrics in-patient. Maybe just in time for Halloween as, if I recall, there are some horror stories to be found in those memories...