Surgery

I’ve been requested to write a short blog post to keep folks up to date on how my surgery rotation is going. The short answer is… surprisingly well. It’s not the most amazing experience I’ve ever had, and I don’t love living away from Durham, but the experience as a whole is definitely not as terrible as I feared. I’m up at 5:30 every day, standing in front of the cafeteria doors promptly at 6am to collect my free breakfast, then off to round with the surgeons at 6:30. I’m sharing this rotation with a Wake Forest PA student, so after rounds, one of us goes to the OR and the other goes to the clinic. If you’re in the clinic, you might have a surgery case first thing right after rounds (before the clinic opens) and/or during your lunch break… or you might get lucky and have one or both of those time slots available to sit in the cafeteria with a cup of coffee and do some studying. If you’re in the OR, it’s a total grab bag; you could knock out two cases and be free for the rest of the day; you could start the day with a light schedule but then fill up with add-ons, or you could go from 7am to after midnight and never see the sun that day. (Those are the days when it’s necessary to take true advantage of the free food and stuff in about 1500 calories for breakfast, because you don’t know when you’ll get to eat again. ;))

As far as skills, there are a lot of fairly easy things like holding retractors, cutting sutures after the surgeon ties them, etc. I’m also doing a lot of laparoscopic camera driving (at which I’m slowly getting better), mostly for gallbladder surgeries (“lap coleys”, for “laparoscopic cholecystectomies”), of which we do quite a few. Now that I’ve been here a week and a half, I’m also suturing a fair amount; I always close the four small incisions we make for the aforementioned lap coleys, and I also closed a pretty long incision after a hernia repair last week. (I mean, sure, it took me about 15 minutes, but it looked pretty good in the end! ;)) I’ve also assisted on a splenectomy, a mastectomy, hernia repairs at various sites, and a few carotid endarterectomies (where they clean the plaque out of the patient’s neck arteries — the chunks of plaque kinda make me rethink those greasy cafeteria breakfasts…).

By my standards, the hours are often long (I might possibly have been crying in the cafeteria on Monday night (too tired, nauseous, headachy, and utterly overwrought after a 16-hour day to muster the wherewithal to bring the food from my plate to my mouth)… but then there are other days, like today, where I’m done early. And overall, it’s the cliche small-town paradigm — everyone here is just so NICE. Granted, when they start talking conservative politics during a case (which is a frequent occurrence) or when they ask me if I’m married (an only slightly less frequent occurrence), I often want to run out of the room ;) but nonetheless… in terms of surgical skills, I don’t feel embarassed, judged, panicked, put on the spot, or expected to know things I don’t, all of which I definitely experienced multiple times in the OR at Duke and which had the combined effect of making me want to stay as far away from surgery as humanly possible. But I have been extremely grateful (and amazed) by how kind and patient everyone is here. Because everybody is okay with the fact that I don’t know very much, and that there are times when I need to be shown something several times (i.e. how to begin a certain stitch), that acceptance makes me okay with it too — as opposed to the Duke dynamic, where if you get it right, nothing is mentioned (because of course you did it right, why wouldn’t you?) and if you get it wrong, you have to cringe while multiple people use stern voices… Anyway, bottom line: while I’m still not going to run out and do surgery as a career, I’m shyly proud of the few small things I’ve learned and done so far, and I’m no longer afraid of the scrubbing-in process (far more intricate and nitpicky than it looks on TV) or of the OR in general, both of which I consider to be victories.

Also, I get free food in the cafeteria, free gym access at the hospital-affiliated gym (which is surprisingly awesome, complete with pool and new cardio equipment), a nice new four-bedroom AHEC house to live in while I’m here (which, at the moment, I share with only one other person, a fellow classmate who’s on his pediatric rotation here), and *weekends off*, which virtually no other surgical rotation gives. So… yeah… overall I’m gonna call this a win.

Aside: Tanzania in 17 days!!!

Tags: Duke, medicine, PA school, stress, Travel

Scrooge

Do others experience this silent waning of annual holiday enthusiasm as the years wear on? I mean, as a kid, I was all about the holidays — I guess most of us are, when we’re that age. Putting up the lights with my dad, decorating the tree with my mom and sister, painting snowflakes on the windows, getting time off from school (well, I guess some things never change), eating lasagna with my grandparents every Christmas Eve, surreptitiously poking at the lumpy, mysterious packages under the tree, the scent of cinnamon rolls on Christmas morning, going downtown for the city ballet’s performance of The Nutcracker, driving around to look at Christmas light displays, the constant undercurrent of Nat King Cole and Charlie Brown and Kenny G echoing through the house… there was always such an air of excitement, a sense in the pit of my stomach that something special was happening. No matter where I was or what I was doing, it was always perfectly clear to me what time of year it was. 

And honestly, even as a young adult, I used to be the first one yanking out all the Christmas decorations, making holiday playlists, forcing myself to wait until Black Friday to go and get the tree. Liz and I used to throw a holiday party every December (which, I can proudly report, I actually attended as a guest this year – and enjoyed immensely), which was always one of my favorite evenings of the entire year. Baking cookies, choosing gifts (and dropping smug, tantalizing hints about said gifts), visiting friends, taking coffee to the men running the Christmas tree lot across from our apartment in 20-degree weather… The traditions and realities were different, but no less special.

Yet for the past two years, things have been very… subdued?

On a personal note, it’s certainly fair to say that I haven’t exactly had a ‘normal’ two years — last year, I was coping with my first year of PA school combined with the shadow of a breakup; this year, it’s the second year of PA school and my first time ever living alone. And although I genuinely, gratefully, wholeheartedly enjoy living on my own (I’m sure there will be a gushing post about my perfect little apartment one of these days), I’m slowly realizing that much of one’s enthusiasm for the holidays comes from having others around, off whom one can bounce various plans, ideas, and anticipation. I mean, I’ve seen a lot of friends lately and have truly been having a blast – but when I come home to my apartment at night, it’s just me. I do have a few holiday decorations out, but honestly, I didn’t even get a tree this year (which is the first time that’s ever happened), mostly because (a) after Wednesday, I won’t be here to enjoy it, and (b) I come home approximately 12 hours before starting my next clinical rotation — meaning I’m not going to have time to tussle with the various logistics that inevitably surround the annual disposal of the Christmas tree.

But I digress. My real question is whether this decline in ‘holiday spirit’ is a product of my personal circumstances, or whether it’s just a common phenomenon as we get older. I suspect that, like most things in life, it’s probably a combination of multiple factors. I know my mom has gotten less and less enthusiastic about the usual traditions since my sister and I have been out of the house, and the whole ‘gift’ side of things also becomes a lot less important once kids are old enough to make most of their own purchases. So maybe it’s just the natural way of things. It’s hard for me to tell, though, because the root of the problem for me right now lies in the fact that it’s just hard to spare any thought toward the existence of Christmas. During school, my world is very ‘small’, very narrowly focused. Laundry and dishes pile up, my workout regimen falls by the wayside, and I rarely have any idea of what’s going on in the world on a national or international scale. And now, on winter break, I’m trying to catch up for the past six months of said narrow focus (you don’t want to see the amount of dust I swept out of my bathroom this morning) — meaning that, although the time crunch is of a different nature, it still exists. I’m still going through some of the holiday motions — playing Christmas carols while I clean, for example — but I just don’t feel the same way about it all that I did when I was a kid.

So is it my wacky, hundred-mile-an-hour life that’s leading me to (mostly) shrug off the significance of what used to be such a special time of year? Or is it just part of growing up? If the former, I can deal with it for one more season. But if it’s the latter… how do I get the old mindset back?

Tags: family, holidays, musings, vacation

Two years later

During this transition from Blogger to WordPress, I’ve found myself not-quite-inadvertently rereading a few of my old posts–specifically, the ones from the latter half of 2009, when I was getting so restless at my peds job and so ready to start school. I actually found myself tearing up in response to one particular entry–not the one where I described my acceptance, as one might expect, but the one from the day after my interview, where I wrote about the process (minus critical details) and my emotions thereafter. I’ve discussed parts of my interview story with my classmates and mentees many times–silly as it sounds, there’s a subtle but very real bond among those in the class who were ‘interview buddies’, and there are two others from my interview day who were also accepted–so I felt like I remembered the logistics pretty well. The part that rendered me misty is the part I’d completely forgotten about writing–where, less than 24 hours after the interview (thus still awaiting a verdict), I described coming to terms with the fact that, you know what, I showed them who I was, and that alone is a victory. Essentially, I’d written that, yes, I wanted Duke so incredibly badly–but even if I were declined, I was nonetheless confident that the decision would be based on me, and the answers I gave, and the personality I showed. In other words: I was proud enough of how I had ’performed’–and, by extension, who I am–that I was ready to accept whatever decision came. That is no small thing. Those emotions–the certainty, the faith, the calm–had gotten lost in the haziness of memory and general craziness of that chunk of time, so it was nice to be reminded.

(Three days later–exactly two years ago today, as it happens–I was accepted. That was a great post, too. :-))

Anyway, it’s nice to reread things like that once in a while, especially this year. I think most of my classmates are liking the clinical year a lot better than the didactic year, and in some senses, I am too. It’s definitely nice to get to direct our own learning, to be more hands-on, to get to apply some of the things we learned last year, to start to zero in on a clearer view of the direction in which we each personally are headed over the longer term. There have been some shining moments, some incredible clinician-teachers, some wonderfully kind patients and rewarding, educational cases. Sometimes, a patient compliments you in front of your preceptor (on the last day of my OBGYN rotation, there was a young woman who asked imploringly if I could be her permanent prenatal care provider), and you feel like you’re about to explode from pride. Maybe I really am learning. Maybe I really can do this.

However, this is also a lonely year. We start completely anew, with a fresh set of people, places, and expectations, every four weeks. It’s rare that anything carries over – the suturing skills we learn in surgery aren’t utilized in psychiatry; the method of oral presentation we’re taught during OBGYN is completely irrelevant during internal medicine. No sooner do you reach the point where you feel like you might possibly halfway understand what this is all about — than you’re moving on. The constant steep spike of the learning curve, inevitably followed by a smackdown plunge back to ground zero on the first day of the next rotation, is made worse by the fact that, most of the time, we’re completely on our own in clinic, isolated from the 70+ classmates who understand what we’re going through. Even when we see one another, our frame of reference is no longer the same; one person is living out of the area on a surgical rotation while another is commuting to a psychiatric facility and someone else is breezing through an enjoyable elective. One person has the blessed consistency of a single preceptor throughout a rotation, while someone else is attempting to make the best possible first impression on a brand new provider every day. Some clinicians love to teach and go out of their way to make sure we’re learning; others, particularly on busier services, know that if they just quietly put up with us for a few hours or days, that we’ll be gone (so ’why bother’ to put in the effort to teach us anything?). There are moments, hours, days, and weeks that are miserable and unrewarding, where every patient is ungrateful, every preceptor is unhelpful, and the vast body of knowledge doesn’t seem like it’s ever going to come together.

I think this is why most of us are starting to get the itch to search for jobs — not because we necessarily feel ready for the responsibility of diagnosing and treating patients alone (good lord, what a terrifying thought), but because a job represents some continuity, a setting in which we might actually remain for a while. We’ll be able to choose our own specialty — primary care, emergency medicine, surgery, whatever we like. With any luck, we’ll get to meet our supervising physician face-to-face beforehand, to make sure we click — what an incredible luxury. We can choose our setting according to our own preferences — inpatient or outpatient, call or no call, 8-hour shifts or 12-hour. And the learning curve can continue to rise for as long as we so choose — not just four weeks, or eight weeks, but for as long as we like. As we’re scrambling to learn the ropes, we’ll actually be doing it for a semi-permanent reason. The idea of a job seems like… the most rewarding elective rotation ever. :-)

I do recognize that it’s good for me to be out of my comfort zone, to be constantly wrong-footed. It is making me better, stronger, humbler, quicker, more articulate, more forgiving. It just gets exhausting after a while, and makes it hard to remember where I’m headed. Struggling to memorize the markings of each individual tree makes the forest disappear. A friend of mine (a fellow Duke grad, but in a different field) described it well: “It is difficult to understand the simultaneous building and stripping of ego that occurs in these programs–you are told you are the best and then every day expected to f—ing prove it. It is exhausting, bewildering, hella fun, and completely brutal.” Yes.

Anyway. To bring this entry back to where it began–I’m trying to incorporate that post-interview mentality, the outlook that I know I had two years ago. All I can do is my very best; all I can hope for is to be the very best Jess that I know how to be. Whatever the various opportunities, pathways, forks in the road that may rise to the surface as a result of that behavior — I’m not in control of those. All I can do is my best. Because if I can manage to do that, then it means that whatever comes next isn’t actually up to me. And there is a certain security in that, as well as a certain freedom. All I have to do is recognize it — whatever it is — when it comes.

Tags: decisions, Duke, emotion, medicine, PA school, stress

For those who care to track my every movement

(a.k.a. the requisite vacation productivity post… so that on January 2nd, when I’m moaning about how much I still have to do and how I really really really don’t want to go back to clinic yet, I’ll have something to look back on and recall that, oh yes, I actually did knock a few things off the list, didn’t I?)  

This is my class’s first break since July 18th, and good grief, have we needed it. (This was supposed to be the ‘easy’ semester, with the outpatient rotations and predictable hours–what does it say about me if I’m this burned out by the end of just those rotations?!) Aside from the fact that we’re exhausted, we’re also more broke than we’ve ever been in our lives (can someone please explain to me why we receive the same amount of aid to cover a nearly-six-month fall semester as we do for the four-month spring and three-month summer?!). The time off has been fantastic in terms of getting things done, though–when you’re in clinic every weekday from 8a-5p, it’s hard to get anything done in your own life. I call it ‘life maintenance’, and I’ve been pretty efficient at it so far:

Saturday — absolutely lovely Starbucks-fueled walk through the Duke Gardens with a classmate, followed by an absolutely lovely Christmas party at Liz’s, capped off by absolutely lovely drinks at Six Plates with another great friend. Magical first day of break.

Sunday – ran treadmill intervals, got a celebratory end-of-semester massage (quote from the therapist regarding my recently painful knees: “I could have spent SO much longer working on you…”), had coffee and brunch at Scratch with a classmate and her beautiful baby, and hung out with one of my awesome c/o 2013 mentees in the evening.

Monday — insanely productive! Canceled my cable, did my grocery shopping, got my yearly physical and Tanzania travel consult (four shots, three prescriptions), got my car’s oil changed and tires rotated, cashed in an about-to-expire LivingSocial to get the car washed and vacuumed, then went to Wine Down Monday (half off all bottles…) at Firebirds with a good friend.

Tuesday — went to the girly doctor (hush; this was a long time coming; there may even be a post about it later, though I promise I won’t go into gory detail), had frozen yogurt with a classmate, then came home, did laundry, and spent entirely too much time finagling my apartment’s electronic setup.

Wednesday — wasted most of the day on this blog migration :-) but also did some pretty serious cleaning and Goodwill-ing. Went to my instructor’s last BodyTone class (*sob*), then went out with some friends.

Thursday — coffee date followed by LivingSocial dinner at Tallula’s with my second awesome 2013 mentee. Not entirely sure where the rest of the day went, which I think is a mark of a successful vacation day…

So far, today has consisted of me sleeping until past noon (!), then being awakened by the phone when the friend I’d promised to meet for lunch called to inquire whether I had perhaps died in my sleep. Anyway, we had a lovely lunch at Vita and now I’m back home. Going to go work out shortly, and then tomorrow I’m having brunch with my third awesome 2013 mentee (yeah, I sort of collect them) and going to dinner and a comedy show with a few Raleigh friends. Sunday I’m helping some good friends move into their recently-purchased first home (!!!). Monday and Tuesday are still mostly open (noteworthy for the Duke-UNCG basketball game on Monday night), and then I’m headed down to Florida on Wednesday to spend some time with my family. I still have a few things to get done before then — some big, some small — but it’s amazing how much ‘cleaner’ my brain feels without all those extraneous small personal-life concerns nibbling around the edges, never able to really make their way in and compete with the things like, oh, a two-hour pediatrics exam or a 45-minute presentation on Tanzania.

17 vacation days left, and I plan to soak up every one of them…

Tags: friends, fun stuff, projects, vacation

Professional Update

So far in the clinical year, I’ve written my research paper on pediatric food allergies (those of you playing the home game may recall that there was a last-minute scheduling explosion about nine days before I was supposed to go to Wilmington for primary care, meaning the paper ended up being my first rotation) and have also finished my rotations in OBGYN (one month), primary care (two months), and pediatrics (one month). There have been some really good days, some wonderful compliments, and some fantastically memorable moments. There have also been some terrible days and quite a few extremely uncomfortable moments. Occasionally, just how far I’ve come and how much knowledge I’ve gained becomes dazzlingly, unbelievably clear to me. Then there are other times when I don’t feel like I’m learning anything at all, like I’m just faking it. The overwhelming majority of the time, I feel like the dumbest person in the room; this is helped only slightly by hearing from every single one of my classmates that they feel exactly the same way. And yet we keep getting up in the morning, keep putting ourselves through it, because we are trying so so hard to ‘trust the system’ and believe that we’re going to come out on the other side knowing what we need to know. It’s still the best thing I’ve ever done, but it’s also still the very very hardest.

Anyway, I’ll get into the emotional side of this a little more in another post, but in terms of a ‘professional update’, the idea of having a job no longer seems quite so far away. I’m still not sure exactly what form that’s going to take, but one way or another, on August 3, 2012, I will theoretically be eligible to take my board exam and begin the rest of my life.

A few options that clatter and bang around in my head at times:

Staying here. At this point, this is still at the top of my list. I absolutely love this area, and I definitely think this is where I want to be on a long-term basis. I have a huge network here and, knock on wood, don’t think I’ll have too much trouble finding a job once I figure out exactly what type of setting I want to be in. At this point, I also don’t think it’s any secret that I’d really like to be on faculty at DPAP someday–maybe not doing a boatload of lecturing, but things like small-group sessions, academic advising, writing exams, doing interviews/admissions, the occasional lecture on something I’m passionate about–those are all things that are really exciting for me to consider.

Going somewhere else. By the same token, precisely because I do have such a large network in the Triangle, it seems as though it could potentially be easy to get ‘stuck’ here if I were to find a job here straight out of school. If I ever want to live anywhere else–if the travel bug isn’t fully satisfied, if I ever want to experience life in a big city, etc.–then this seems like the logical time to do so, with the goal of returning to the Triangle after a couple of years.

The PA residency in OBGYN at Montefiore Medical Center in NYC. Until hearing about this, I hadn’t put a lot of serious thought (okay, any serious thought) into the idea of a residency, because the majority of them are for critical care or surgery or emergency med–not things I’m particularly interested in. But, depending on how my interests evolve over the next few months, I would consider this one. Besides pediatrics, my next-favorite field is OB… and regarding the above line of thinking about living somewhere else for a while, NYC would definitely be my top choice. We shall see.

International work—clinical or otherwise. Yeah, there’s Africa, South America, and so forth–but also, the Netherlands uses PAs now, and they might welcome an American-trained PA (who speaks Dutch) to get involved on the educational side of their university programs.

Something else that I haven’t experienced yet. My next rotation is pediatric hematology/oncology, so I’ll get to experience the inpatient side of pediatrics for the first time. Also still to come are surgery, psychiatry, emergency med, internal med, and of course Tanzania. I’ll be curious to see whether these next 7-8 months just feel like ‘marking time’, or whether something else will actually jump out at me as a potential future career interest. We’ll see what develops.

Tags: confusion, decisions, Duke, NYC, PA school, stress