Kind of a Big Deal!

So, I've been about bursting with the news, and now it's official. Rocky and the little guy are going to have a baby to protect, starting in August. By ultrasound our due date is August 5th. My sis's bday and our anniversary. By dates, I am due on August 12th, so you know, somewhere in between would be a-ok.

It's a pretty great story, how we found out. We knew having a baby 4th year would be pretty perfect for us. Lenient schedule, lots of flexibility. So it was in the works. As lots of you know, though, I have endometriosis. Not a huge deal, but can get a bit painful when I'm off birth control for long lengths of time. It was reaching that time. So my preceptor, who I'm thrilled to say is now my OB, was planning a surgery in the beginning of Dec to clean me up. An added bonus of the surgery is the increase in fertility following so it would be perfect. J and I showed up that morning all set to go, got the IV going, left some pee in a cup, and we were wheeling back to the OR. The anesthesiologist gave me some Versed, wicked stuff that cuts the anxiety, and I was pretty out of it. I scooted over to the OR bed and that's when things started to get a bit hazy. I remember Dr. B saying we couldn't do the surgery because I was pregnant. And I remember bawling my head off when the pre-op nurse handed me the positive tests in a ziplock baggie for me to keep. I remember crying and asking if I would remember this (because Versed has amnestic properties-can't shut off the med student in me), and I remember coming out of my haze and seeing the pictures J took on his phone of me clutching positive pee tests to my chest and crying like a little girl. It was a pretty great day.

I'm really excited, but I know I'll be even more excited when I'm done with internal medicine and have more time to think about getting the house ready. But being in medicine when you're pregnant has it's benefits! It is really great to have immediate access to ultrasound whenever I want. And Dr. B is always excited to see the baby. I've had 6 ultrasounds already, and he's pretty sure of the sex...but I won't post that 'till he will commit to it for sure!

Anyway, we're excited. Very excited. And even more excited to be out of the first trimester. Zofran was my best friend. I am starting to feel like a new person, but really tired. Could be partly due to internal medicine. So in four weeks, bliss.

Skool is hrd

So, let me start out by saying that internal medicine is not for me. I had guessed this before I even started by 3rd year. I didn't really have a reason for it at that point though. I knew I didn't like to round for hours on end, and that was as far as I ever got. Well, I've learned a lot about myself, internal medicine, aging, all sorts of stuff really, in the last 2 and a half weeks.

I ended up getting extremely lucky (again!) with my assignment for a rotation. I am spending this first 4 weeks at St. Joe's. I'm in love with the place. Internal medicine here would be wonderful, if you're into that kind of thing. They work on a night float system which means no overnight call unless your on Friday or Saturday. This makes for happy residents from what I can tell. Call on the week days involves admitting until 7, then finishing up what you've started, and leaving by 9. The day usually starts around 7 am. These are great hours for internal medicine. Truly. During the day the teaching is exceptional. Every day there is morning report where different teams on the wards and the unit present interesting cases and we all sit around and generate a differential diagnosis a la "House". It's a great way to learn. Then at noon there is a conference every day where an attending presents an important topic to help with patient care. Oh, and they provide lunch at that conference every day (M-F). Then there is a teaching attending assigned to each ward team who meets with the team for at least 3 hours a week. For us, we present a patient and go through the House-esque routine again. Then we see the patient and all assign each other a topic to look up to help us better understand the case. It's great experience. Once a week we do the same with the head of the department. It's busy, very little down time, and I am pressed to get my progress notes done in a timely fashion, but so worth it.

So, no, it's not the rounding or hours that deters me from internal medicine. It's just the type of patients internal medicine sees. They are so complicated!!! Me, I like to look at a single problem at a time: i.e. baby's coming, I better catch it! Somewhere along those lines. Internal medicine is complex, with each patient having 10 medical issues that are all intertwined and all of which need addressing. These docs are the thinkers. They have to look at it all. It's easy to miss stuff. I told my resident today I don't think I'm smart enough to do what she does. And that's not necessarily what I think, but it's close. I am just at my best when I can know a whole lot about a smaller area. It gives me confidence that I won't miss something huge because I'm so bogged down with the details. I give those docs credit. They are amazing. And I am lucky to have a great team that really is invested in my learning. My resident even told me she thinks it's her job to make sure when I go to the U next month that I look like a rock star. I'm learning so much, but it's taxing and I'm tired - even with this great schedule. The patients can be very sad, lots of end of life issues.

But there's a lot of hope in this field too, so I see why people like it. I actually had a patient who was 98, and when I walked into the room for the first time and saw him lying there, I turned around and walked out because I was sure that was a 60 year old! Nope, 98. "I climbed a lot of mountains in my day." That's his secret. Guess J was right about that afterall.

I only have a week and a half left at St. Joe's. Then I'm back to academic medicine. I'm pretty sure that type of medicine, any field - not just internal - is not for me. I like private practice. I like how nice people are, and I like how they still respect you as a person while acknowledging the fact that there so much more to learn. My experience at the U has been one of a very strict heirarchy. A place where you never forget your "station." It's only 4 weeks. It's only 4 weeks. It's only 4 weeks...

Holiday break!

The holidays are finally here! Last night we had an early Christmas dinner with J's family and tomorrow we leave for the great White North. I'm so looking forward to seeing my family! There are just some parts of holidays from home that really resonate with you and make them sseem more like holidays. That and we'll most definitely have a white Christmas! Hopefully I'll be more motivated to blog when we get back. Have a great holiday!!

2/3

Well, tomorrow this time I will be done with surgery, for now. Feeling under the weather has made me do the one thing I vowed would not happen during third year....I missed work. And I mean a fair amount of work. Enough work to be forced to make it up after 3rd year is over. Blah. Of course this happens when I have just made a sparkly schedule for 4th year (at least an outline in my head) that would maximize my chances for a Denver residency. But oh, well. All is not lost I that front I think. I'll just need to come up with a slightly different timing.

If I don't include the time I need to make up for surgery, I have 16 short weeks separating me from the end of my clinical 3rd year experience. I know it seems silly that I would be counting that down. This is what I want to do, no? Well, yes and no. Ever since I let myself come to the concusion, the very real conclusion, that the only area of medicine that will really make me happy is OB/Gyn, I find it much harder to get excited about the upcoming internal medicine rotation. Family practice should be better, I might actually get to deliver a baby and do women's health-y things during that block. Fourth year is going to be much more exciting as I will be doing the things that I want to do for a living. Now I'm pretty much 2/3 of the way through my 3rd year and really looking forward to the future.

And all along the way I still have my preceptor visits. Today is an exam day and I'm still going in to see him. I just learn so much from even watching him interact with his patients. Not to mention it's a once a week dose of what I want to do.

I'm also super pumped to head up North to see the fam for Christmas. I am excited for the change of scenery, even if the change is to a flat, white expanse that's so cold the exhaust from the relatively few cars hangs in the air like a San Fransisco fog. But more importantly my fam is part of that change of scenery and I'm excited to see them. Lots of relaxing, baking and Wii playing.

Of course, I still have a week of class on "Death and Grief." So cheery for the holidays. Great timing school of medicine - well done.

I'm starting to get the blah-blah-blahs. It seems to happen in every block, that point where you are over the initial excitement/nervousness, and just ready for it to be done. I've enjoyed my time in surgery, but I'm starting to question whether I'm learning anything useful at this point. You have to wonder whether it's important for me to hold a camera to see yet another gallbladder taken out, or a retractor to see another lumpectomy when these are things I'll likely never see again, and have seen many times thus far. I just need to heed the advice one of the OB residents had for me on my rotation - enjoy all these things you'll do this year as much as you can secure in the knowlege that if you hate it; you'll never have to do it again. I only have 9 more days I need to go into the hospital for this block, and that's pretty great too. I'm looking forward to heading up to the Great White North for a week to see my family. I love Christmas and I'm looking forward to celebrating.

I am getting pretty antsy to just GO somewhere I have to say. Christmas trip notwithstanding I think it might be time to plan a mini vacation...

Thankful

So, taking a cue from a friend on facebook, I thought I'd write about what I'm thankful for. First, I'm thankful for my family and friends. I could not make it through this year, or this path in life, without them and their unending support. Being able to have someone come to pick up the dogs when we need, someone to help me by cooking some dinner when I can't get home in time, people to just vent at when work is tough; these are things that are priceless and that I couldn't live without. I am so lucky.

I'm thankful that I have all my faculties and that, even though med school is hard, it is not as hard for me as it is for some. I am thankful that I don't have to study as much as some people which gives me more time with those I care about.

I'm thankful I have found such fantastic mentors all along the way that will hopefully continue to be fantastic mentors and collegues throughout my career.

I'm thankful that I can be a part of patient care. I'm thankful that even though I can't, right now, take out someone's cancer, that I have the ability to offer empathy and compassion when the others around me don't have time to do so.

I'm thankful that I didn't find out today I have pancreatic cancer, unlike my patient. I'm thankful I could be there for them when all the pieces fell apart, and I'm thankful they have a great family to be there for them as they get put back together.

A Few Things

Surgery has been a positive experience (so far) in so many ways:

1) I know what I want to be when I grow up! (No, for real this time!) Barring some life-altering event in the next year, I will be applying for a residency in Ob/Gyn. I've learned from my rotation that I love the OR. It's my favorite place in the hospital; well, favorite next to labor and delivery. I also have learned that I really don't mind heading to the hospital at 4am on a Sunday when it's to do something I enjoy. Knowing that makes the idea of a tough residency (as if any are easy) much more palatable. I've learned that I am tougher than I thought I was and that I can take what's given and smile knowing that in the end, I win! I get to do what I have wanted to do for so long.

2) I gots myself tough. Getting told you're dumb all day everyday will make it run right off ya.

3) I've learned how to be a more effective team member and, someday, a better senior resident, etc. How did I learn this? By watching what my chief does and knowing that I can do so much better. I've had some great teachers, and the people coming behind me deserve the same.

4) One handed knot tying is sexy.

5) Having a beer after 3 nights of call is the best beer you'll ever have!