“It’s time for academic global health to act according to science, not fear.”

I spent today at the annual Consortium of Universities for Global Health conference in San Francisco and am inspired. This is one of the things I love about academia: meetings like this just really feed my soul. I love hearing the inspiration of others doing amazing work: it is inspiring.

Jason Cone, US director of MSF, spoke to us about his concern of fear aversion that is so prominent among the academics. We were silent, he said, during the Ebola crisis. And yet we speak of missions about working where we are most needed and reaching the least fortunate. The most need is in fragile states wracked by conflict, and going there is a calculated risk that those of us committed to global health must take. And these institutions must adapt to support us, not block our going.

And Richard Horton, editor of the Lancet, spoke about planetary health, a movement about the health of human civilization and the natural systems upon which it relies. Our health depends upon the ground below us and sky above us, and this we must admit.

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A med student’s surgical dream.

On Friday, one of the chief resident’s interns was off, and I was in his operating room for the day. The procedures were simple ones, so he didn’t need the attending to scrub in. It was just the two of us, and this resident was a teacher. On our first case, an umbilical hernia repair, he opened and dissected, pulling up tracts of tissue that he would spread across a hemostat and handing me the cautery so I could do all the cutting (!). On the second case, a 5 cm lipoma excision from the center of a man’s back, I made the cut and developed the tension planes while he did the clipping, and with a tug I pulled the tumor out of its little pocket. Afterwards I stitched him close with vertical mattress stitches. The final case was a split thickness skin graft to a non healing midline abdominal wound. Here I observed, just retracting here and there, as the attending scrubbed in to help with the grafting equipment.

What a day Those are the kind of days that make being a third year med student worth it.

“To be rooted is perhaps the most important and least recognized need if the human soul

Today, on my second post call day of my third year surgery clerkship, I rolled into bed around 5:30 am and slept until around 11, when my dear husband brought me some cereal and I propped myself up in bed to watch Chopped. I had coffee, worked out, relaxed, hit the rock climbing gym with husband and had frozen pizza. And yet I feel a little weird. Maybe stressed, maybe tired. Not sure really. I wonder if I am simply ungrounded. I selected a new book to read during my early morning me time and am commiting to daily morning yoga this week, in hopes that it will anchor me down and bring some peace.

Overnights.

I left the VA around 5:30 this evening, after prerounding on patients, scrubbing on a 6 hour surgery, and attending a Morbidity and Mortality conference. On my way out I bought a large coffee from the hospital coffee shop, which explains why I am still awake at 1:15 am when nothing is going on. The intern has gone to lay down but the hospital is short on call rooms, as one is under construction. There are two reclining arm chairs in the lounge but the overnight OR staff lays claim to them as soon as we step out to see night of surgery patients. My fellow med student is snoozing in the corner in a computer chair with his feet propped up on a desk and I have set up at a small table. I have read my chapters for today and have settled in with neurosurgery memoir I’ve been reading in my spare time, drifting off occasionally. Not much going on tonight. 

On Call.

I have been on surgery for one week today. Already, I am tired.

Last Thursday, I woke at 3 am. I read and drank coffee and wrote a bit and left for the hospital at 5. I saw my patients and wrote my notes and helped change a wound vac before clinic began at 7:30. At the hospital I’m at we spend Tuesday and Thursday in the clinics: on Thursday, we start with proctology, then do general surgery, then vascular. I cut open a couple of abscesses, which was the day’s saving grace in an otherwise rather boring string of cases. I was not made to spend my days in the clinic.

After clinic I got in my car and headed downtown to a different hospital for call. My hospital is considered a little too uneventful for students to take call there, so we are assigned to different hospitals overnight. I find my buddy, a med student that is there for days as well so he can serve as my guide. We spend some time in the lounge before the the intern we are assigned to gets his first call, and we go: we try to talk a patient out of leaving against medical advice and we insert a central venous catheter and an arterial line in a patient in the ICU. We take a dinner break then come back to the lounge, where I do a little bit of reading before we settle into the armchairs in the lounge to watch the Office. Within a few minutes we are all drifting off to sleep until the intern gets paged. We go and insert a chest tube, then report to the ER where we insert a femoral line, starting over at one point because the patient vomits blood on our sterile field. Oops.

We get consulted on a new patient with an incarcerated hernia, so we go and see him, only to learn that the hernia is not quite incarcerated after all, as we can shove it back in. At this point it is about time to begin pre-rounds, and generally I could be sent home since I don’t have patients at this hospital. But today we have Grand Rounds so I have to stick around, so I tag along behind the intern as he pre-rounds.

I spend Grand Rounds fighting so hard to stay awake, but failing most of the time. Finally I am released, not being required to stay for the next two conferences since I am post call. I head home and go on a quick breakfast date with my husband before collapsing into bed and not fully regaining consciousness for a day and a half.

That was Friday. Today is Monday, and tonight, I am on call.

Keep Exploring

My husband wears this navy trucker hat, to which he sewed a red patch with white lettering that proclaims, “KEEP EXPLORING!” Several days ago, he worked through a big, messy, emotional struggle which ended in him quitting his job to put all of his energy into running in an effort to really make the Olympic team when he runs the Marathon trials in February. This culminated in a lot of relief on his part, and a day or two after the fact, he sighed heavily and told me he had made the right decision. And that now, he could look at that patch and feel like it meant something again.

That’s a question, isn’t it? Am I exploring? I have recently stepped into a place in which I am indescribably busy: I work long days at the hospital on my clerkships, and study as hard as I can manage with the intention of honoring myself exams. When I’m not doing those things, I have papers I want to be writing, phone calls with collaborators on Global Health projects I want to be making, posters I want to be arranging, piles of articles I want to be reading, meetings I want to be taking, and applications I want to be filling out. Most of it is a consequence of that talk from the chair of Internal Medicine, that convinced me so intensely that I need to aim by arrow and shoot already: that is, decide what I want to be, and go be it. To stop expecting the road to direct itself, I’m taking step after step after step.

Let me say here that this is not a bad thing. I don’t feel overwhelmed or stressed (most of the time) because the things I am doing are things I am just so passionate about. I am thrilled. I am ecstatic. I am in a place in which I pause multiple times per day and marvel at how right it all feels. There are new things around every corner, and life is progressing, and it is all so fun. It’s time consuming and vigorous and difficult, but so fun. I have to encourage you, friends, that if you don’t have things on your to-do list that you are a passionate about, give a thought to that. What’s amazing to me is the fact that if I were only working and studying, I know that I would feel downtrodden, burdened, apathetic, and exhausted. But if I add these inspiration, life-giving things to my plate? Everyday I have such reason to get up, and I go to bed tired but I’m so satisfied with the effort I put in each day.

Neurosurgery.

A few days ago I kept an appointment with the head of the Department of Neurosurgery at my institution. Weird. Taking a step back here: when people ask me what I want to do with my life, I always say surgery. But more and more, with each passing day, really, I know that that’s a lie, because I’m really no longer on planning on pursuing a general surgery residency. I have a confession to make: I want to be a neurosurgeon.

Casual view you get while waiting for the elevators to leave your corner office on the 15 floor when you’re the head of the Neurosurgery department. NBD.

I don’t know what I beat around the bush on this, or why I am so hesitant to admit it to people. I suppose I feel like it puts a lot of pressure on me, because while lots of my friends want to be surgeons, I only know of one other person rolling around the notion of pursuing neurosurgery. And he’s different, because he had brain cancer and a neurosurgeon saved his life. But. Steadfast as I have always been in my desire to be a surgeon, I did not know what type. But my first year of medical school, we took a Neuro class, and that was the first class I ever earned Honors in. I loved it. It all made so much sense, and at the same time it was interesting enough to keep my attention through the man
y hours that it required to learn. But then second year came along, and I did well at several different things. I was an immensely better student second year. So was it just that I had just started trying around the time that Neuro happened, and nothing to do with the subject itself? Maybe. Then second year ended and I studied for Step 1, and the days I spe
nt on neuro made me certain: neuro makes my heart sing. (Refer to an episode of Grey’s Anatomy in which Callie asks April is placing a k-wire will make her heart sing, and then tells her that if it does she should do it). And the more I pictured it, the more my heart sang. Fast forward to a week or so ago, when the Chair of the Department
of Internal Medicine scheduled a pizza lunch with the med students on rotation. The focus of his talk was knowing where you’re going to be in 30 years. Med students have a tendency to err on the side of uncertainty, wanting to keep their options open. But open options does not a passionate person make. They cause apathy and uncertainty and half-hearted humans. So, he told us, stop expecting the road itself to take you where you will end up. Decide what you want, figure out what it takes to get there, and do that. Ok. Message received. I’m going to be a neurosurgeon.

Meltdown.

I had this moment, last Monday or Tuesday or so, where I had thought I had figured it out. I made this sweet schedule (making schedules is my happy place, my zen, my highest calling in life) to keep me on track for studying.

Gratitude and Rest.

Today I am grateful for days off to rest, clean, restore, catch up.

For long, slow, yoga sessions that melt that rock-climbing soreness away.

For the ability to alternate between a cool, silent, living room and bustling coffee shop.

I am very much enjoying this Saturday to myself. I slept in, woke up slowly,and got in a good workout. I made my way to the coffee shop for a solid 4 hours of catch-up studying before I felt like I really needed a break. Studying for me right now consists of reading Step Up to Medicine to really get my hands around what a third year needs to know, making Anki flashcards on management, treatment, and assessment of patients (since all of this is so very new to a baby third year) and doing UWorld questions from the Step 2 CK Question Bank. I’m thinking of adding in a little Case Files when I have a chance, just to make some of the reading more clinical.

I returned home, took a tv break, and then studied a touch more before setting off on a good, therapeutic, deep clean of the apartment. Later tonight, I’m going with my husband to watch him and his buds run a Beer Mile: 4 laps around a standard track with a 12 oz beer, at least 5% alcohol of greater per official regulations, in between each lap. They are nuts but someone needs to be able to drive them home.

The best thing about Saturdays—when you get weekends off—is that there is also Sunday to come. Bliss.

A Day on a Subspecialty Medicine Service

Today is my last day on GI, and thus the end of the first half of Internal Medicine! I have to say that while I’m still striving to balance it all and stay rested, time has flown. I imagine that’s probably how third year is going to proceed.

So here’s a little snapshot into a day on GI. Let me note here that one of the more interesting