Tests and tea.

For the first time in what seems like months I feel well rested and really excited. I was granted the last day of clinicals off to study for my exam, and my dog actually let me sleep until almost 9! I do plan on studying a lot today but I also plan to stop my whole foods for some delicious grub for dinner to celebrate the end of a very tough clerkship. And no one's more surprised than me that I liked it. My patients were very interesting and I couldn't have gotten luckier for my team. My residents and interns were super helpful and let me have just the right amount of autonomy. My attending was a really great teacher both on rounds and in these didactic lectures he prepared for us. When I saw the last group of students leave the U at the midpoint of this block, I was sure I would hate it. They looked exhausted and so UNHAPPY! But, though I am exhausted (or was last night), I am not unhappy with my experience. And the best news of all, one of my patients is getting written up for a journal and I'm going to be published! If I got nothing else out of this rotation, which I did, that would be worth enough.

Even better is knowing what the weekend brings. Yes, I have a crazy hard test on Friday morning, and a less hard but still irritating test on Thursday morning, but then the fun begins! My sister is coming in while I'm taking said crazy hard test and will be at my house when I'm done! That's the day we'll find out the sex of the baby, so that's pretty exciting too! We're doing 5280 week for dinner and I'm super excited about it. Then Saturday we're going to the Celestial Seasonings Tea Factory for their tour. I haven't been there since I've been a little kid and it just seems like a good thing to do when you're pregnant and can't go to the beer tours :-(. It feels good to have lots to look forward to and some time to rest before it all goes down.

But a question, anything up in Boulder that we absolutely shouldn't miss while we're up there? I really would love to go to Redstone meadery, but I don't really think my sister would like it, and as previously mentioned, alcohol and pregnancy etc. But any place to eat or see on a February day you can think of? Comments appreciated.

Getting there

Well, I'm over half done with my time at the U. I am exhausted. This week I have Friday off since I am on call next weekend. Two more call days. I don't sleep so well at night these days, and I pay for it during the afternoon when the work slows down but I'm still stuck in the hospital. Since today is pre-call I am hoping we'll get out a little early, but we picked up a ton of patients on Friday call and haven't discharged very many. Which means we'll probably be pretty busy trying to get that accomplished today before we are on call again tomorrow. It makes me feel a bit less optimistic about the finish line when I'm so tired and I'm starting to get sick (I am never sick, is it kosher to blame the unborn?).

But there really is a bright side. I have 9 work days left of internal medicine. And on the really bright side, I do not hate it as much as I thought I would. I've been lucky to have a good team that is interested in making sure I learn lots and make me feel like I'm helpful,and when there's nothing to do, they make sure I get out of there. And at the end of the tunnel my little sister is coming out for a visit! And at that point I will have only one more rotation in my third year. Today or tomorrow I should get my fourth year schedule, and I'm really, really hoping to get the sub-internship (aka acting like an intern, not getting paid) I hoped for in May. It'll give me some peace of mind to know I'll get through the 4th year requirements and that I'll graduate on time even with the baby.

If I can just make it through 9 more days of squeezing like a sardine into my normal clothes I will be a happy camper. Four of those days are call or post-call, so those are scrubs days. And I have to thank my dear friend D who hooked me up with some more options for when my normal clothes are no longer an option. You are the best!

Hopefully I'll write about some of my weird stories in the days to come. But if not, I'll catch you all on the other side of medicine.

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...