Applying to residency

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I’m sitting here reviewing the residency programs I’m interested in applying to, and even though I’ve chosen a specialty, I feel like I’m standing beneath this sign. Each program offering opportunity and experience that I am equally excited about, but each different enough that I can’t fully imagine where they’ll lead.  Where to next??

Good luck with applications!

– S

My day in family medicine

Left: The panic moments before my preceptor finishes his lead-in to a pathophysiology question about the kidney — and I suddenly forget we even have kidneys

Middle: Taking an extensive HPI & ROS before coffee or after 6pm.

Right: When I’m anticipating every possible medical question my preceptor could ask and he throws me off with literature or pop-culture trivia.

[link to source]

Cervix

Last week I finished 6 weeks of my first rotation of 3rd year: OBGYN.

It was more challenging yet invigorating and motivating than I imagined.

Let’s start at the weekend before my 1st day. After our orientation July 2, I made my way to Seattle for a surprise birthday party for one of my dear friends. His brilliantly talented girlfriend started his birthday toast with a story about her cat named Cervix.

This is Cervix.

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The story was endearing & heartfelt, but I didn’t realize until the following Monday that it also served as a prologue to my next 6 weeks and my quest to find the cervix. I’ll leave it up to you to refresh yourself on the anatomy, but I didn’t realize how something so easy to identify could be so challenging when baby’s head is smashing down on it. As a mother approaches term, the cervix flattens and softens, but it’s a small piece of anatomy and a small space – how hard would it be to navigate? This assumption was mistake #1. I felt nothing on my first few exams, but as I continued to be confused about what I was or wasn’t feeling, I quickly became frustrated. At one point, I don’t know what was harder – figuring out what I was feeling or trying to hide my confused face to the patient while I was doing the exam. I was unnecessarily hard on myself after several failed attempts, and it was easy to feel inadequate when the doctor, nurse and patient looked at me expectantly after finishing my exam, only for me to look sheepish and give the quick shake of the head no. The turning point started when a nurse dusted off the “vagina in a box” teaching tool.

Vag in a box

Not to mention the several very patient nurses coaching me through each exam – and of course, all the forgiving patients who encouraged me to basically stay the course during an exam until I found it. At about exam 25, I felt it more clearly (and more posteriorly) than I ever had and it’s been a relief for everyone since.

My preceptor was fantastic. On my 2nd day I scrubbed into an urgent c-section and also had a woman present in labor after a full day of seeing patients. Wanting to see the whole process, I stayed at  the hospital that evening to see all the steps leading up to the birth. At 2am, the nurse and I started a trial of pushing with the patient. As I held one of the legs, and the delivery was quickly nearing, the doctor walked in.  Having not yet seen him perform a delivery, I thought I would watch and assist however I could. Instead, he immediately told me to gown up and sit down. I was excitedly terrified – so focused, yet everything was a blur. He guided me through the entire thing and before I knew it, I delivered my first baby and tremulously (!) completed my first laceration repair. And the rotation didn’t slow down for the next 6 weeks. In total, I completed 15 vaginal deliveries and whatever repairs were necessary, and assisted with 10 c-sections with varying degrees of responsibility. It was intense. And I loved it.

It surprised me to have liked the gynecological aspect as much as I did – this specialty is much more than delivering babies. Women’s health is such a fundamental, yet understated, aspect of health & well-being. And it’s extremely vulnerable. I felt such a privilege to be a part of helping women with infertility to incontinence, and everything in between.

Some reflections & lessons learned from OB:

  • It’s easy to feel inadequate. I felt like an idiot ** A lot ** I had to keep reminding myself that not only was this my first in-depth exposure to OBGyn, but it was my first rotation EVER. And I’m a student, not a resident. It’s easy to think that it’s your job to advance your skill level to that of your preceptor and the nurses — especially with a specialty you love.  I was pushing myself hard to make sure it’s wasn’t just a “honeymoon” phase of ditching the classroom for clinicals. Regardless, I had to remind myself (& be reminded) those skills take years to evolve. And while it’s important to develop as many skills and learn as many things as I could, at the end of the day, I was still trying this specialty on to see if it fit me, and more importantly, I still had a shelf exam to pass at the end of the rotation, so I couldn’t get too bogged down in the “doing” of medicine.
  • Not every delivery is a feel good moment, and there is a lot of heartache that comes with this specialty. This hit me the most in the first week when immediately after I delivered a healthy baby girl, we went directly to the operating room to perform a D&C for a woman who had miscarried for the 3rd  time. The quick transition from the “high” after a healthy delivery to being present and comforting to a woman who was scared and sad, and delivering a baby that didn’t make it, was an important learning point that can’t be taught in the classroom. As challenging as it was, I walked away wanting to be there just as much for the woman who delivered the healthy baby as the one who was repeatedly experiencing unexpected loss.
  • The special moments in the Dr/patient relationship. Most c-sections I watched were planned and the women would receive spinal anesthesia after being moved to the operating room. It was here that I witnessed one of the most tender and compassionate moments between the surgeon and patient. Here is this woman, nervously excited for the delivery of her baby, being asked to sit hunched over her full term belly, perfectly still, for an uncomfortable procedure in a room full of surgical equipment and surrounded by gowned and masked people bustling about. The surgeon walks in and holds the woman’s hand as she folds over her belly while the anesthesia is placed. He stands close and almost instinctively, each woman would rest her head on his shoulder and he would quietly coach each of them through what they were feeling and provide encouragement and reassurance. And the whole room was quiet. It’s one of the most impactful displays of human connection that I have ever seen and I hope to provide that level of comfort and reassurance to my patients.

Overall, this was a phenomenal rotation and set the bar high for my clinical years. At the end of my first week, I was already feeling disappointment that I would only be doing this for 6 weeks. By the end of the 6th week, I was surprisingly sad that I wasn’t going to be doing this for the next 3 years. I think this is a good sign. We’ll see where the next rotation leads me.

-stacey

Mangia Bene

DiMeo dinner

Finally, a food post!

Nari and I had the pleasure of joining a few of our classmates for a delightful Italian meal at the home of two of our clinical skills faculty. I suppose “meal” doesn’t really do the evening justice — it was a full Italian dining experience from the moment we arrived.

75 degrees and sunny, we couldn’t have asked for a more gorgeous day and appropriately started the afternoon on the back patio with citrus-infused water and a delightfully smooth Aglianico.  We then got a crash course in the basics of “pie art” (and dough making) and watched them masterfully construct a few pizza varieties, including the classic margherita — all of which were devoured after a quick cook in a Black Stone pizza oven (something I am adding to my “when I grow up” wish list). I haven’t had pizza this good in a really long time and it took a lot of self-control to heed their cautionary warning to save room for the main course.

Of course, the main course didn’t disappoint — fresh asparagus, homemade lasagna, and meatballs & sauce, plus some ridiculously good chicken. We topped the evening off with espresso & “Nonna-made” cucidati — a true treat.

The food was incredible, but the most enjoyable part was being able to sit down and enjoy a meal & conversation together.  This was a welcomed change of pace from the usual devour & scavenge-food-when-you-can mentality of school.

In total, we spent 6.5 hours visiting and eating. More impressively, our gracious hosts spent most of the day cooking before our arrival. Even though events like this consume a significant portion of the day, they remind me of the powerful role of food to unite people, preserve cultural traditions and promote health through both the well-balanced home-cooked meals themselves as well as the relationships built while sharing food together.

To our wonderful hosts — molte grazie. We are very fortunate to have such warm & caring faculty — especially ones who enjoy sharing their culinary skills!

-stacey

Transitions

As Nari mentioned, our last classes of 2nd year were Friday. The day felt surreal (perhaps in part due to Dr. Goldman’s magic tricks), though more likely due to the sudden realization that I was one step closer to moving from my home in this high-desert valley hugged by rolling yellow hills, to a small, maritime community in Grays Harbor County.

I have a mixture of emotions with this transition. I am excited to finally emerge from the books and into the wards, yet also unsure of how I will be able to translate the foundation of medicine to practice. Similarly, my adventurous side craves exploring new places, and I have been fortunate to have several opportunities to try out different communities near and far, so I am eager to explore and find my place in this new town. However, it comes with some sadness as I leave this valley that I have become so connected with — both in place and person.

Maybe it was the spring storm that blew into town yesterday, or the love of a good show tune, but today I’ve had Dick Van Dyke’s “Winds in the East” tune rolling around in my mind.

Ready or not, the transition is happening. And it starts with tomorrow’s 8a OPP final, so I suppose I should get back to studying.

To new experiences and forever embracing change, and the growth that comes with it —

stacey