Male or Female?

So going along with the post two days ago, here is a chest xray (from a google search) a lot worse than what I found... Seriously, this person's xray is making me cringe. I see at least 5 fractures on the left side of the picture (which is the right side of the patient), and all that cloudiness is probably fluid (blood) or contused lung parenchyma from a severe blunt trauma to the right side of the chest. No bueno.

Here's a normal chest xray of someone that I found on google images.

Now here's a question for you that my radiology professors asked us from my first year of medical school in anatomy class...

What sex is the patient in the second xray? And how can you tell?

Its actually really prominent and obvious in this picture, but I'll wait for someone to guess! :)

~~~~~~~~~~~~~~~~~~~~

COUNTDOWN TO GRADUATION: 3 DAYS!!

Expiration Dates

I had a great weekend... Started off Friday night with catching up with really close friends. It was even more fun since we all haven't been in the same city at the same time with nothing to do in a while. Then Saturday afternoon/evening/night was my high school friend's wedding. They really knew how to throw a party, and I had soooo much fun even though I ended up getting a speeding ticket on my way to the wedding (ugh!). I needed all day Sunday to recover from the wedding. I finally have a new phone, and I jumped the iphone bandwagon. I got the white 32 Gb iphone 4s, and I actually like it a lot. It really easy to use and figure out, and I'm loving the battery. I got really fed up with my Android phone that wouldn't last the whole day even if I didn't use it. Now, I'm just waiting on my case to get here before I can breathe easy haha. I've been treating it like its a fragile egg.

Anyways, at the wedding, my friends from high school and I were *finally* shocked to realize that someone who was so close to us got married when so many of us still don't feel like we're 26/27. I know  don't feel that way. I think it hit a lot of them that woah, when did we grow up?? We're not teenagers anymore! I know several of my high school friends have no interest in settling down until they reach 30. I don't think I have a certain age where a switch is suddenly turned on where I'd settle for anyone. But, I'm pretty sure I don't think I want to settle down for at least a while... Whether that's a year or three years, I don't know. All I know is that I want to focus on residency instead of looking for someone to get married to. I wish everyone would respect and understand that.

I love being South Asian, but I also hate our culture sometimes. I hate the fact that my entire life I've been taught that education is the key to everything and boys/boyfriends are frivolous (and bad/sinful) while growing up. So I never once let boys distract me from my path to my career. Sure, I liked guys and gushed over who was hot and who was not and who was sweet or what my dream "type" of guy would be, but I never made acting upon all that a priority, and I never pursued anyone. When I was graduating high school, I thought that I would meet someone and everything would just magically fall into place and I'd be married by age 25. Things haven't happened the way I've wanted them to, and 25 seemed old to the 17 year old me. I bumped into the four relationships (only one serious one though) that I've been in on accident. I really believed that *someone* and I were meant to be... But he didn't feel the same way about me at all. I know this because he wouldn't have run away when the parents gave him an ultimatum (commit to get engaged or else), and he wouldn't have suddenly, magically remembered his life long dream of pursuing medicine after years of being in the business world at around the same time, which also happened to be the ultimate deal-breaker for me. But my point was that I've never actively pursued anyone. I've only been pursued... and then dumped. If I could go back in time and talk to the 17 year old me, oh the things I would tell her and warn her about. I'd tell her to focus on school and career like my parents emphasized, but my reasoning would be that she can only ever count on herself and to never become emotionally dependent on a boy.

Once I became of "acceptable marrying age," which to my parents seemed to be 23ish after my first year of med school, they asked me to flip the switch and find someone to get married to. asap. I hate the entire half-arranged marriage process that we're supposed to go through if we can't find and bring someone acceptable to them. It was not that bad in the beginning just because I was so busy studying that I didn't care, but slowly, its gotten worse and worse. Before it was just asking around friends of friends about anyone they knew who would be looking and exchanging pictures... When that failed,  it became the damn matrimonial website, which my parents put me on without my permission... That hasn't produced any results either, and now its some random lady who has a matrimonial service for the area we live in. Ugh.

Through all of that, I basically feel like I'm being pimped out and being put on sale by my parents. I feel like I have no value as a person through these processes, and no one cares. The mothers who are looking for someone for their sons only have a checklist that says, "young, tall, slim, beautiful" with an occasional "professional degree" thrown in the mix. I'm so tired of it. My parents are having a harder and harder time trying to find a guy (any guy!) for me, and I'm losing interest in the idea of settling down. I'm almost 27, which in our culture is almost the end of my "viable shelf life"... Meaning that I'm about to "expire"... Meaning that I'm only a few years away from being too old to be suitable for marriage anymore. And as my age keeps creeping up, my parents are getting more and more desperate.

But honestly, I'd much rather just focus on something that I know will be happening for me, like residency. I don't want to waste time focusing on or thinking about something so abstract, fickle, and unreliable as love, relationships, or marriage. Its not worth it, and eff it, I'm almost a doctor.

Until the next one then.

~~~~~~~~~~~~~~~~~~~~

COUNTDOWN TO GRADUATION: 4 DAYS!!

Chest X-Ray ABCs

If you haven't noticed by now, I've been trying to do a post-a-day thing with my graduation countdown at the bottom. Its been kind of hard keeping up with it sometimes.

I leave you with the following story from the night shift on my ER rotation during the first half of my fourth year.

Night shifts were always rough for me. I didn't really have a problem going on nights after working days since I'm naturally a night owl, and I'm able to stay up until about 2am before I really crash. To prepare for those long night shifts, however, I'd sleep a lot during the day. Like until 4pm when staying in bed any longer made me feel pretty gross about myself. Shifts were 12 hours long for both days and nights (duh!), but day shifts just flew by. The ER would be slammed with patients all day, and there was never a shortage of things that needed to be done or patients to be seen. The beginning of the night shift would start out really busy but the incoming patients would taper off around 2 or 3am, and stay relatively slow until the shift was over at 7am. It could get really really boring. I would read books, read articles that were homework, and text *someone* nonstop during the night. The slow ER is what bored me to tears. Sometimes even reading my book was boring...

One patient who came in was a supposedly drunk middle aged lady, who also supposedly had some mental handicaps. The specifics of what that might have been was unclear. She came in reeking of alcohol, and complaining about pain on the left side of her chest. All she was able to tell us was that she had fallen... When or where or how was a mystery. She didn't have the capacity to accurately answer our questions. On exam, she was extremely tender on the left side of her chest. She screamed and nearly jumped off the stretcher when we tried to palpate the area. I felt really bad for this lady though. Instead of only having one or two sets of hands pushing around in the painful area, she had like four people examine here -- the nurse, me the med student, the medicine resident, and the ER faculty. Because she was such a poor historian, everyone else was inclined to think that she was either faking or just wanted to have a safe place to sleep for a few hours. I wasn't so sure. I thought she had a rib fracture, but the intern disagreed only because of her poor history giving skills.

However, since a lot of medicine is all about covering your butt, they still ordered a chest xray (which is what I was pushing for too). There is a separate radiology department for the ER where there is an upper level resident or maybe even faculty who reads all of the imaging studies that have been ordered for the entire ER. There is also a special computer in the ER physicians' office where all of the imaging studies can be pulled up for review by the physicians and students in the office. We got the official report as dictated by the radiologist, who read the chest xray as normal. The ER attending barely glanced at the chest xray itself and nearly discharged the patient with orders to take ibuprofen for the pain. Now, since I had a strong suspicion of a rib fracture and because I like looking at xrays (and CTs and MRIs lol), I went over the xray very systematically and very slowly.

They teach the ABC method of looking at xrays:
A - airways (midline, patent?)
B - bones (fractures or lytic lesions?)
C - cardiac silhouette (normal? appx half of the chest width?)
D - diaphragm (flattened or elevated? symmetric? air under it?)
E - edges of the heart (well defined or not to rule out any fluid in the lungs)
F - fields (lung fields well inflated? any effusions, infiltrates or nodules?)
G - gastric bubble (present?)
H - hilum (nodes or masses?)
I - presence of any instruments? (ET tubes, central lines, NG tubes, etc)
[I had to look up each letter and what it meant. I'm usually good with A-D and F]

I didn't have to go through it very far. I was checking her bones, and I followed each rib on the left side from the vertebrae until it disappeared (this is where the bony part of the ribs are attached to the cartilage of the ribs which is then attached to the sternum). And guess what I found?

Two rib fractures in ribs 6 and 7 on the left side... That both the radiologist and my ER attending missed.  I stopped my attending from discharging the patient so fast by saying, "Dr so and so, I think she has two rib fractures here!" He double checked what I found, told me I was correct, and then called the radiologist to change his note. That conversation went something like... "Dr radiologist, this is Dr So and So, I'm calling in regards to Ms Chest Pain. My medical student pointed out that she has two rib fractures on the left side..." [it would have been much cooler if he called me his "astute medical student" though.]

I don't want to sound cocky, but I was really proud of myself that day. I figured out a differential diagnosis based on her history and exam, and it happened to be what was on the top of my list. More importantly, I helped a lady be diagnosed correctly and get discharged with actual pain medications instead of just ibuprofen. Unfortunately though, there's not much that can be done for rib fractures other than to let them heal on their own and to provide pain relief in the mean time.

My concern is that the ER attending, radiologist, and the medicine resident who were working that night all missed it. They all have many many years of more experience in both treating patients and reading xrays than me. How did this happen?! I want to give them the benefit of the doubt and say that they were tired and in a rush, and the rib fractures were really subtle. So if someone were to glance at it quickly, then they would probably overlook it. I was actually looking for rib fractures because I really believed that's what had to be wrong. However, even then, I think someone should have seen the fracture first. If you're working the night shift, I feel like you should be prepared and awake... The med student shouldn't be catching their mistakes. Thoughts?

Until the next one then.

~~~~~~~~~~~~~~~~~~~~

COUNTDOWN TO GRADUATION: 7 DAYS!!

Why Breakups* Suck.

*especially the ones that end in heartbreak!

Going along with my last post which was the more rational medicaly/doctory side of me, is this post which is the less-rational-girl-who's-recently-been-dumped-again side of me.

- Pain. To say that it hurts would be putting it lightly. When you really think you're meant to end up with someone, only to have them walk out on you, it completely shocks and then it crushes you and rips you apart. Ugly crying is a distinct possibility here, and for some people, its a certainty.

- Self pity. Everyone has a phase of crying/being sad/moping around the house feeling sorry for themselves. Its probably the ugliest stage, even more hideous than the ugly crying. This is when people let themselves go completely for any given time, refuse to shave, rarely shower, etc as seen on tv. Its when you don't want to look nice for anyone. You want to stay in your nastiest pair of sweats all day listening to sad break up songs and watching romantic comedies and wondering why those happy endings are never seem to happen to you.

- Declining self esteem. A lot of it is based on not understanding what happened or how things went wrong, only to assume that it was your fault even if in reality, it wasn't. You start to think that there's something terribly wrong with you, that you're not pretty enough, not skinny enough, not smart enough, not desirable enough, not lovable or wantable enough. That list can go on and on. And that sort of thinking damages you. Its not healthy, but its inevitable. It doesn't matter how much your friends try to cheer you up or try to convince you other wise, in your head, you know best. And you think you're right and will always be right. You think that no one will ever want to be with you ever again, and you shut out everyone else who tries to help you.

- Then after all that, you reach a certain calm level of sadness. You've accepted that the two of you aren't meant to be, but you're also feeling your lowest about yourself, and you've convinced yourself that he/she has probably moved on by now since there's no possible way they'd be feeling this bad. They were the dump-er (no poop jokes please!), and you were the dump-ee. They must be happier without you since this is what they wanted. Its a resignation of well, life keeps going on, work keeps going on, family continues to need you, etc. The pain is dull here, but still deep and fresh enough to where you occasionally cry yourself to sleep at night. It might have been something you saw, perhaps driving by the place you first spent a whole weekend together, or something you remember, perhaps the first time you told them how you felt with the L word, or it might just be that time of the month and your hormones are kicking your emotional side into overdrive. You're still able to socialize like a normal person and smile, laugh, and joke around, but that pain is still in there. You feel it, but no one else can see it.

- Occasionally there's anger towards the other person and all happy couples. I think the anger towards the other person is self-explanatory and makes complete sense. When you've been snubbed, your knee jerk reaction might be to push the other person away even farther. Or revenge. It just depends on they type of person you are. But every one of your non-single friends will keep spouting the same garbage about how "everything happens for a reason" and "he wasn't the one" and "it just wasn't meant to be for the two of you" and "stop whining and get over it already" and "you'll find your soul-mate soon, look how quickly I found mine!" Seriously? Dear friends in happy relationships, don't give advice to your newly single friends even if they are your best friends. They do not want to hear it. Its not helpful right after a breakup. You should ease into it a little while later. All your heartbroken friend needs is comfortable silence, a shoulder to cry on, and an open environment so if he/she says, "I miss him/her, and I want him/her back," you won't interject with a giant, "ITS OKAY. HE WASN'T THE ONE. EVERYTHING HAPPENS FOR A REASON, AND I KNOW YOU'LL MEET THE GUY/GIRL OF YOUR DREAMS ONE DAY." Its not helpful. Trust me.

- Faith in love is destroyed. You (the dump-ee) start believing that love doesn't exist. That its a delusion shared by two people (also known as a shared psychotic disorder in psychiatry, fyi). You stop thinking that everyone ends up marrying their soul-mates. You start to question whether or not soul-mates even exist. You promise yourself you won't ever be fooled again. That you won't let a smile or a hug or a kiss melt your heart even a little ever again. Its too risky to become vulnerable. Then finally you convince yourself you're better off alone than ever risking your heart like that ever again. Because pain like that shouldn't ever happen to anyone more than once.

Until the next one then.

~~~~~~~~~~~~~~~~~~~~

COUNTDOWN TO GRADUATION: 9 DAYS!!

Bereavement vs Heartbreak

While I was on my psychiatry rotation, I had a lot of difficulty discerning the difference between normal bereavement (grieving from a death) and adjustment disorder caused by a heartbreak. Everyone laughed at me and only gave me the explanation that death is so much worse. Umm, yeah I understood that, but my point was that patients suffering from both will have similar symptoms, and I also argued that in both, there's a loss of someone in your life and you still go through all the stages of grief to get over it.

Denial - "This can't be really happening."
Anger - "Why did this have to happen to me?! Its not fair!"
Bargaining - "I'll do anything to have more time with you. Just come back to me."
Depression - "What's the point to life without that person? Who cares?"
Acceptance - "I guess I'll be okay, and there are things to look forward to without that person here."

Maybe it all just seemed too similar for me for my exams. I'm sure DSM-IV (the psych book of diagnostic criteria for every disorder) probably is more specific, and I honestly don't remember what it said. Those books are still sitting in my med school apt. However, all I remember is being really really confused since almost everything going on in a person's head is the same in both.

Maybe this is why I'm not cut out for psych. Too many shades of gray when it comes to people and their psychiatric well being. Who's to say going through the bereavement like states isn't normal for a person who had their heart crushed? There's just so much overlap. I guess I like a lot of things with clear cut answers. History of alcohol abuse and LFTs elevated over 500? Acute alcoholic hepatitis. Done. TSH has sky rocketed through the roof and you're cold, constipated, and balding? Hypothyroidism. Done. Right lower quadrant belly pain, nausea, vomiting, fever, constipation? Appendicitis, let's get you into CT and then surgery. Done. Everything in psych is so fluid and even the criteria can be bent a little. Differential diagnoses are often listed as "rule out _____ disorder," and often times, there's not really a test that can be done other than watching and waiting to see how long these symptoms continue. I didn't like that. So I decided no psychiatry for me even though it was really interesting.

Until the next one then.

~~~~~~~~~~~~~~~~~~~~

COUNTDOWN TO GRADUATION: 10 DAYS!!

My New Vanity Basket

So I'm tired of all the cheap-o bathroom stuff I've had for the past 4 years. My set was a $10 one from Ikea that I don't even like very much. I only bought it because it was cheap. I want to change things up for my new apartment. The great thing about my new bathroom is that the tub has a sliding glass door, so I don't need a shower curtain! This is so exciting to me since I hate when the water leaks out from around my shower curtain, onto the floor, soaking whatever bathroom mats I might have. The other great thing about my new apartment's bathroom is that there is sooo much counter space! The sink is connected to the counter, but it forms an "L" shape to the right of the sink. Essentially, one entire wall of the bathroom is counterspace! There's even space under the counter to put a little vanity chair/stool. I'm super excited about the bathroom. Since I don't need a shower curtain, all I really need is the bathroom accessories set... 

And I loooove this one from Bed, Bath, and Beyond. For everyone who knows me, I love anything if it shines and sparkles with rhinestones and sequins! (Seriously, I do. Its become an addiction with me. I have shoes and flip-flops with sequins and rhinestones, and I have so many sequined tank tops/shirts. For my Indian clothes, the more it sparkles, the better!) Anyways, this set is plain black, and its encrusted with white/clear rhinestones. Perfect for me! Before I found that set at Bed, Bath, and Beyond, I had bought a simple turquoise blue basket that I was going to turn into a gift basket for someone, but I found a similar bigger purple one for that purpose instead. I decided I'd keep the blue basket and just use it as a vanity basket to hold my lotions, body sprays, hair products, everyday make up, and etc for my new bathroom. My only issue was that... My basket wouldn't match everything else! Today, while I was walking around the craft stores near by my house (since my mom dragged me with her), I had a really good and really cheap idea... Why not decorate the basket to match?

I started off with all of those items that I found for less than $10 at the craft store. The big satin rose was on clearance for $1, and the fancy sequined ribbon was for 50% off for $2, so I saved maybe $4. With my hot glue gun from 7th grade and a small tube of super glue in hand, I turned all of that into this:

Picture taken with basket on the back surface with the rose on the front surface facing the light

To be used like this:

And like this (from another angle):

It looked pretty great without the rhinestones, but I wanted to give it some element that would make it look like it matched the bathroom set. I found some really nice bath rugs that are the same shade of blue as my basket this past weekend, and now all I need are matching blue towels. Now everything matches!

By the way, this is NOT the bathroom that my new vanity basket is going to live in. I won't be moving there until the first week of July.

This entire project took me about two hours from start to finish. I have absolutely nothing to do, so this provided me with some distraction from everything going on in my head and around me. Loved doing it. What do you think?

Since I have an additional purple basket that I'm making into a gift basket for someone for graduation, I'm thinking of doing a similar, simpler, an even more girly design (read: lots of hot pink and flowers) for her since she's still a teenager. I don't have supplies for it yet, but it will give me something to do! I'll post a pic once I'm done with that one.

Until the next one then.

~~~~~~~~~~~~~~~~~~~~

COUNTDOWN TO GRADUATION: 11 DAYS!!

Always Wash Your Hands

In medicine, they teach you to become germophobes and be aware of handwashing techniques. Its for a good reason too. Not only will you be preventing the spread of certain diseases and bacteria/viruses, but most importantly, you'll be protecting yourself against being exposed to things that you shouldn't be. The simplest way they teach to to do that is by washing your hands. Before you see a patient. After you see a patient. Before procedures. After procedures. After you blow your nose. After you watch a patient cough into their hand and then proceed to shake your hand. After touching questionable doorknobs in clinics. The list goes on and on.

In the real world, every clinic I have worked at has had antibacterial hand gel sanitizer dispensers outside of every patient room. So before entering, I'd gel it up, and after I'd leave, I'd gel it up again. It became a habit.  I'd only wash my hands in the room with the patient after examining diabetic feet (ewwwwww, its one of the reasons I'm not going into adult medicine), examining someone sweaty (eww again), or doing a procedure of some sort. Anyways, I use hand sanitizers all the freakin time. Even when I'm not in clinic or at the hospital, I'll feel better after I've cleaned my hands.

Sometimes, I'm acutely aware of which part of my hands have touched something "dirty" that now has to be sanitized. I think that hyperacuity comes with being trained in working with the sterile technique, where everything blue (or green depending on the hospital) can't be touched by anything unsterile. I learned to watch myself and all parts of myself to prevent contaminating any sterile field. Plus, I got yelled at by the scrub techs a couple of times while I was on surgery. All of those things together made me hyperaware of what I've touched and what needs to be washed.

In the exam environment, usually with the med school's OSCEs (Objective Structured Clinical Examinations) and even the USMLE Step 2 CS (Clinical Skills), washing your hands is usually the last thing on your mind, but its the easiest way to gain points (or lose points depending on which way you look at it). I know for a fact during my 3.5 years of med school when we had OSCEs, I'd always have to consciously remember to walk into the SP's room and wash my hands at the sink first. (SPs are standardized patients, basically actors hired by the school to memorize a script and only answer to what we students ask.) It made introductions really awkward, but it was the only way that evaluators could see that yes, we actually wash our hands before every patient we see. The CS exam is the OSCE of all OSCEs, and it counts as one of our board exams that we absolutely have to pass to be licensed. There are 11 patient encounters for 20 minutes each (I think?) and then 10 minutes between each encounter to either answer questions or write a clinic note. That was a really high pressure exam, and it moved very very quickly. Even as a germophobe and all the hand cleaning habits I formed, I forgot to wash my hands before THREE patient encounters. Oh. My. Gosh. I nearly panicked once I realized what I forgot and I prayed that I wouldn't fail just because of that. Thankfully, I remembered to wash my hands inside each room for each encounter after that, and thankfully I managed to pass! :)

I realized later why I kept forgetting........ I hadn't taken an OSCE in over 9 months, and there were no hand sanitizer dispensers outside the rooms, and that's where my habit bit me in the butt. These exams are really not representative of what we do normally, but they need a standardized exam to put us all somewhere on some vague scale. All that matters is that I passed.

Until the next one then.

~~~~~~~~~~~~~~~~~~~~

COUNTDOWN TO GRADUATION: 12 DAYS!!

Rant on Tshirts

I love tshirts from the guys section. They're longer, looser, and have cooler designs/graphics. I've gotten so many up until now. And I've turned into a walking ad for the different sodas... (2 Dr Pepper, 2 Coke, Pepsi, Sprite, Fanta, Mountain Dew) They're all I wore on my Puerto Rico trip since they were so light and comfortable. I'll occasionally get tshirts from the girl's (err... women's) side, but I always have to make sure I have the right type of pants on first, make sure its loose enough to my liking, and make sure its not too low cut, see through, or short. And on top of that, the sleeves are often time non-existant, and since I am not comfortable wearing almost sleeveless shirts, it means that I have to either layer with a long sleeved shirt underneath or a wrap/cardigan on top. Seriously?! Doesn't having to make things so complicated for a simple tshirt go against what a tshirt is all about? I like tshirts that I can just throw on for a quick trip to the grocery store, mall, or post office. I am not about to pull out my work clothes to look nice for stupid errands. I don't want to have to worry about the cut or rise of my jeans with my tshirts. I want to be able to throw on my oldest, most comfy, and softest pair of jeans with my soft tshirts on the weekends. I want to be able to relax and be comfortable on the weekends. So that's why I've started buying tshirts from the guys section. It also helps that I'm not a tiny petite girl, and that the smalls in the guys section fit me pretty well. Plus, who doesn't love a tshirt with pacman on it with the words "nom nom nom" under it? :)

There's a specific Dr Pepper one that I want... It says "Trust me, I'm a doctor," and if anyone surprises me with it, I will love you foreverrrr!!

Until the next one then.

~~~~~~~~~~~~~~~~~~~~


COUNTDOWN TO GRADUATION: 14 DAYS!!

The First Time I was Hit On...

...by one of my patients.

Another one of my patients that I will never forget happened to also be during my A/I rotation. He was another asthmatic who was transferred from the PICU after being intubated (i.e. breathing tube down his throat and into his airways). He was quite possibly the most adorable 17 month old little boy I've ever had the pleasure of meeting.He was so friendly, and so cute, and he was wearing a tiny tshirt with shorts, and his hair was going in all directions like an afro. He also had a really big family with everyone there just for him. I went into the room, introduced myself to the family and to the baby, but my introduction to the baby was more or less saying "hiiii, how are you doing?" in a babyish sing-song voice, holding my hand out to him, and playing with his toys with him. Now, I'm not sure if you've ever seen the pediatric wards in a hospital, but the beds all range from small cribs for infants, large cribs for toddlers, even larger cribs for older patients who have decreased mental capabilities (usually a genetic disorder), and regular sized beds. This little boy was in the large crib so he was standing and he ended up being at the same level as my face. He wouldn't stop grabbing my ID badge or my stethoscope even though his crib was littered with toys. Anyways, I checked him out, and he was doing really well. He really didn't even need to be in the intermediate unit. As I was leaving, someone from his family (I think it was Grandma), said, " Hey [insert baby's name], be nice and blow the nice doctor a kiss!" And he did. I was laughing as I turned to leave. I heard him blow a kiss again, followed by him calling out, "Babe!" I was already out the door when I poked my head back in and asked the family, "did he just call me what I think he did??" Of course, they were all in tears laughing so hard. I was laughing all the way back to the nurses station.

Haha, what are you people teaching your son/grandson?

It still made my day though. Since we were still together at that time, I told *someone* that he had some competition, and that *someone* was losing to a 17 month old little boy. He knew I was joking, but it would have been nice if he had stepped it up a little bit more.

Until the next one then.

~~~~~~~~~~~~~~~~

COUNTDOWN TO GRADUATION: 15 DAYS!!

Quotations...

I've been feeling kind of down for a couple of days, mainly because I keep thinking about *someone.* I've even had several dreams about him, which leaves me wondering the big question of WHY is he still on my mind often enough that I'm still dreaming about him? I feel like most normal girls would have at least stopped thinking about the breakup and their ex, but nooooo not me. I'm a sentimental idiot.

I leave you with the following quotes that made me a little teary...

"I try to talk to you, but I don't know what to say. I am afraid you don't want me to say anything. So I don't. But inside me, there are words waiting to come out. And tell you how I feel--like how I miss you. And how I love you despite my broken heart. And how I need you in my life. And especially how much I want you. But those words may forever stay in my heart--locked inside. Sometimes I wonder if there are words locked inside you too... but I'll never know."

"Yes I love him. I love him more than anything else in this world and there is nothing that I would like better than to hold on to him forever. But I know its not for the best. So no matter how much my heart is going to break, I've got to let him go so he can know just how much I love him. Maybe if I'm lucky, he'll come back, but if not, I can make it through this."

"I miss you when something really good happens, because you are the one I want to share it with. I miss you when something is troubling me, because you are the one who understands me so well. I miss you when I laugh and cry because I know that you are the one that makes my laughter grow and my tears disappear. I miss you all the time, but I miss you the most when I lay awake at night and think of all the wonderful times we spent with each other; for those were some of the best times of my life."

"Have you ever been in love? Horrible, isn't it? It makes you so vulnerable. It opens your chest and it opens up your heart and it means that someone can get inside you and mess you up. You build up all these defenses, you build up a whole suit of armor, so that nothing can hurt you, then one stupid person, no different from any other stupid person, wanders into your stupid life... You give them a piece of you. They didn't ask for it. They did something dumb one day, like kiss you or smile at you, and then your life isn't your own anymore. Love takes hostages. It gets inside you. It eats you out and leaves you crying in the darkness, so simple a phrase like 'maybe we should just be friends' turns into a glass splinter working its way into your heart. It hurts. Not just in the imagination. Not just imagination. Its a soul-hurt, a real gets-inside-you-and-rips-you-apart pain. I hate love." -Neil Gaiman

For my friends who have never experienced heartbreak in a relationship since theirs have resulted in marriage and commitment, I don't expect yall to ever understand.

Until the next one then.

~~~~~~~~~~~~~~~~~~~~

COUNTDOWN TO GRADUATION: 16 DAYS!!

Froggie Asthma

Here's a story from my fourth year of med school as an A/I (acting intern)...

A/Is, also known as sub-Is, are fourth year med students who are doing a rotation in the field they want to go into as someone who is auditioning or practicing to become an intern the following year. This rotation is often one of our most important ones since so many of us want to look exceptional in our faculty's eyes so we might be able to get a stellar letter of recommendation for residency. For most pediatrics programs, we needed three. I got one from my internal medicine inpatient rotation (with the best faculty physician in the ENTIRE world), and two from my A/I rotation. Because I was am awesome.

While on that rotation, I was on the intermediate care unit. I took care of lots of kids who were too sick for the normal wards but not sick enough for admission to the PICU. I saw lots of kids with asthma. I got really good at recognizing how much longer a patient needed to be on the high dose albuterol nebulizer treatments and when it was appropriate to wean to a lower dose. I got really good at differentiating between good wheezes and bad wheezes and even bad wheezes that masqueraded as good wheezes. My stethoscope was my best friend during that rotation.

Out of all those kids, a few stand out and I don't think I'd ever forget them. One of my patients was in our hospital intermediate care unit for about 3 days... I'm not exactly sure how long he was there on our floor, but I know I'll never forget him. He was so sick when he came, and he was being pounded with continuous albuterol nebulizers and IV steroids. He looked absolutely miserable. What was even more striking is that this little 6 year old boy also had alopecia universalis, an autoimmune disorder that caused all the hairs on his body to fall out so he was completely bald and with no eyebrows. Anyways, asthmatics always require frequent lung sound checks since each one can respond to the treatment differently. Sometimes, they can respond quite quickly, only with one treatment, and sometimes it takes hours and hours of continuous treatment. After the third time I came in his room to check on him, he got used to me and seemed to be comfortable around me. His mom knew me by name by the end of the day. When I came back the next day, he was doing even better and was on a lower dose of medication every hour. He looked so much better too. He was able to sit up, play video games with his brother, and even talk about how much he loved robots and dinosaurs. By the end of that day, he was doing fairly well, but he wasn't improving as much as we had expected, so we had to go back up on meds. Unfortunately, this was a step backwards, and that happens all the time if someone's dose is decreased too quickly. His spirit stayed positive, and he even knew the routine whenever I walked in to check his lungs. He would sit up straight and lift up his shirt and say, "I'm ready!!" which made me laugh each time. The end of the second day was no different, and he did the same. His airways sounded much more open to me, and I told him, "well it sounds like you have a bunch of frogs in your chest who chased out all the mice!" He looked at me, nodded like what I was saying was no big deal to him, and nonchalantly said, "yeah I know, I put them there."

I love spunky kids.

Until the next one then.

~~~~~~~~~~~~~~~~~~~~

COUNTDOWN TO GRADUATION: 17 DAYS!!

Match Day

For someone who has absolutely nothing to do, I have no idea where my time has been going. I thought I'd end up writing about Match Day a few days after my last post, but those few days were busy since I was getting ready to go on my awesome end-of-med-school/grad-gift-from-my-parents vacation to Puerto Rico (which was amazing btw). Then after I got back, I needed a few days to have a vacation from my vacation since I was so tired. But, those stories are for a different day.

So Match Day. Where do I start?

Match Day is probably the most important day of a student's medical education. I think the white coat ceremony and graduation come close after it. Everything a student has worked towards for four years comes down to that one day. To those two emails. To that one piece of paper. It tells us where we will be for the next three to seven years of our lives. It tells us that we really will be doctors in that field. For some of us, especially the ones going into super competitive fields, Match week is a nightmare. I don't know how these guys were able to deal with all that anxiety. I applied to categorical pediatric programs, which is relatively non-competitive, so I wasn't nearly as worried as some of my other classmates who applied to competitive programs (i.e. Hopkins) and specialties (i.e. ortho or plastics). From the day I submitted my rank list of residency programs online at the end of January, I was fairly confident that I would match somewhere, and I was fairly confident about the order of how I ranked everything. I had other stuff going on in my personal life with *someone* since December that was causing me significantly more anxiety and stress than the match was... I guess the stress over him and over match was intertwined. I was worried about what would happen with us if I didn't end up in my #1 ranked place, and I reallyyy didn't want to be in a long distance relationship through residency... But, that stress was taken away at the beginning of February when things abruptly ended between us, so I stopped caring where I wanted to match. It didn't really matter to me anymore. Some part of that may have been  due to my broken heart, or maybe some of that may have been my practicality, who knows? I just know I had stopped worrying about where I'd end up.

However, even with that said, I was a raging ball of nerves the weekend before Match week. Sunday night was rough. I could not sleep because I was just tossing and turning, and I couldn't help but to wonder if my confidence was borderlining on the side of cockiness. All I could think about were the what-ifs the whole night.
What if I don't match? I didn't pay any attention on how to do SOAP!! [SOAP is the matching program for the people who didn't match. Basically they'd see what positions were still open and apply to them during match week. Super stressful.]
What if I match to the bottom of my list?
What if I match into Program #3 and I'm unhappy there?
What if its not my number 1 program? Then those thoughts began to clear and I realized it would be okay if I matched to Program #3 or the bottom of my list because all that mattered at this point was if I matched! On Monday March 12th, we all found out if we matched somewhere. All we got was an email at 11am saying, "Congratulations. You have matched." That's it. But that's all I needed. So with a big sigh of relief, I knew I'd be a pediatrician after three years somewhere, but I had to wait until Friday to find out where.

The wait between Monday morning to Friday morning was the longest wait I have ever encountered. I'm so glad that our school had a bunch of festivities lined up the entire week starting with Monday night and ending Saturday night. If I didn't have those events to distract me, the wait would have been even longer! Those events were fun and it was really awesome seeing everyone from my class again. I saw people that I haven't seen in two years after they moved to the other two cities for clinical rotations! I think other than graduation, that was the only time everyone was finally back in the same city. There were dinners, bar tabs, a boat party, and even a formal dinner the whole week... Lots of fun!

Match day itself was on Friday, and was... anticlimactic unfortunately :(
My family came into town the night before so they'd be at the ceremony on time and without rushing. I had to be on campus earlier for class pictures and a class meeting that was completely useless but still a lot of fun since we had some silly awards to give out. During the actual ceremony, they called us one by one in random order to the stage to get our envelopes containing a printed out match letter telling us which program we matched into. Now, I had an issue with the way things were done here. They had three people calling out names at any given time, one of the microphones was not working properly, and they kept trying to encourage us to be loud and energetic. They rotated the announcers and some were fine and able to shout over the microphone and over the noise, and some were not able to. Can you tell where my story is going? I was on the edge of my seat the whole time waiting for my name. I was completely wired, shaky, and nervous, and I was definitely paying attention to whose names they were calling. It was hard to hear what was going on with all the noise and the non-functioning microphone. So I heard all of my friends' named be called except one and they were down to the last two envelopes so we thought it was all for the two of us................. except that the second to last name called was another girl's and the last one to be called was my friend's............

So then I had a small freak out moment. Where the heck was my envelope??? Was that email a glitch??? Did I really not match??? Then my head cleared and I headed to the stage.

My envelope was still on the stupid stage. Apparently, the microphone had stopped working, and the guy with the microphone was unable to shout over the noise of the students, so I didn't hear my name be called. The lady holding my envelope was really really rude to me and said "we called your name three times" in a condescending tone as if it were my fault the announcer couldn't speak over the noise. Umm I'm pretty sure I would have heard my name especially with how intently I was listening, and even if I didn't hear it, my friends would have. This was my career that I would be finding out about, so of course I was listening! But most importantly, no one heard my name being called!! Maybe she just didn't want to admit it was their fault for not checking the microphones ahead of time.

My envelope!

So I didn't get the rush of going up to the stage after hearing my name and getting my envelope while my classmates were watching... Oh well. That was so disappointing, and it put me in a slightly bad mood. It stuck with me the whole afternoon. Anyways, as I returned to my seat, my hands were shaking as I opened it to see... *drumroll*... that I had matched to my #1 program!! I was happy and upset at the same time. Part of me was was ecstatic and dancing in my head singing, "yes, I got my number one!!" but another part of me was much more solemn saying, "wow, I really did end up with my number one which I had decided on because it seemed like a good fit in addition to being in the same city as *someone*..." That second part of me was sad because I was just thinking about him, and how I had put high priority on this program so we'd be able to be together through all of it... I'm not saying I didn't like the program. I did and I do, and I'm glad I will be there. Its just after I realized I liked the program, I thought everything would fall into place with *someone* but that was my mistake, and I was reminded of it after matching.

My Match Day Letter

So I was happy and sad, and I wasn't able to have my time on stage. I ended up getting the same message in my email two hours later, which was kinda cool. I guess that's how non-US med students applying to residency in the US would find out where they matched. I was actually pretty disappointed with Match Day especially since I was so excited for it back before *someone* and I broke up. Sigh.

More stories coming soon! I have lots :)

Until the next one then.