Better

Last night I was asked by a patient, “How long have you been a doctor?”  My reply:  “Three weeks sir.”  If that doesn’t instill confidence in a person, I don’t know what will.

But it has been only three weeks.  Yet, somehow, it feels like a lot more.  Maybe it’s because I’m blogging right after a 14-hour night shift.  Maybe it’s because I’m exhausted and tired and hungry.  Or maybe it’s because deep down I’m feeling completely overwhelmed.

Being a doctor is hard.  The hours are long.  I barely get to see my family.  My brain hurts.  My feet hurt.  I could go on and on.  But I’m not one to complain (yeah right).  But in all seriousness, I feel completely overwhelmed.  So far my experience of being a doctor is one in which every single day I feel inadequate.  Every day I’m confronted with my own personal flaws and intellectual deficits.  I’m constantly asked questions that I don’t know the answer to.  And I’m frequently confronted with decisions that could be life-or-death, all of which I feel unprepared to address.

And today was the first time that I really messed up.  I can’t describe in too many details the case or what happened.  But basically I ordered too high of a dose of a medication for a patient.  I didn’t kill the patient or anything, but an attending brought it to my attention.  I took full responsibility.  I took the blame.  And it sucked.

Not because I got yelled at.  Not because I was embarrassed.  But because I did something that wasn’t the right thing to do for my patient.  And it feels awful.  And in the grand scheme of things it was a very small mistake that had only minor consequences.  But it hurts.  It hurts deep down knowing that my best wasn’t good enough.  I  should have known that it was too high of a dose.  I should have known the effect that it would have.  And I just didn’t.

It just amazes me that after four years of medical school I can still know so little.  I feel like I’m an intelligent person.  I;ve always gotten good grades and good test scores.  But medicine is such a complicated field.  No two cases are exactly the same.  And there is an infinite amount of things to know.

It’s very hard not to get discouraged.  Logically I know that I’m just starting my training and that this is normal.  I see the residents who are one year or two years ahead of me in their training, and I see how much they know.  I’m hope that I get there eventually, too.

But right now it seems almost impossible.  It seems like I have so far to go and so much more to learn.  I feel like I should know more for where I’m at.  And I feel like my patients deserve better.

So for now, I have to stomach the fact that I screwed up.  I made a mistake.  And I have to get over it.  I won’t make this mistake again.  But there will be others.  Lots and lots of other mistakes.  But in some ways this motivates me to work harder and study more and continue to learn as much as I can and ask as many questions possible.

I hope I’m not as dumb as I feel.  I really hope that it wasn’t a mistake that somebody let me call myself “doctor.”  And I hope that tomorrow I can do better.

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The Scorpion

I’m not sure which was the more terrifying experience for me this week: finding a scorpion in my living room or starting Intern year in the ICU.  We’ll call it a tie.

There is such a huge jump from being a medical student to being a doctor, and until it actually happens you really have no idea how big that jump is.  As a medical student everything is theoretical.  But as an Intern, when someone asks you what you want to do, they actually want you to do it.  And you should probably actually know the answer instead of guess.

Or you could do what I do and just ask the nurse.  My favorite part about working in the ICU is that the nurses are all pretty good.  They’ve been around longer than I have and so far they have all been very nice.

One very friendly young nurse kept coming up to me and saying, “Dr. Howard, the patient in Bed 8 needs this.” Or, “Dr. Howard, what do you want to give to this patient.”  After about the third time I said, “You know it really freaks me out when you call me Dr. Howard.  You can just call me Emily.”  She had a good laugh, but I was being completely serious.

It’s very strange to be Dr. Howard.  It still takes me a second to respond when someone calls me that.  I still forget and introduce myself to patients as Emily.  And I always fumble to find the words when I’m talking on the phone.  “Dr. Howard” sounds like someone who knows what she’s doing, and that is not me.

I do love the ICU, though.  And even though it’s a scary place to start as an Intern, in many ways it feels like home.  The familiar sounds of beeping ventilators and IV machines.  The familiar faces of the nurses and attendings who I met during my student rotation.  And lots and lots of sick patients.

So far I haven’t killed anyone.  I’ve gotten to do several procedures.  I’m slowly learning how to use the hospital’s computer system to write notes and orders.  And little by little I feel like I’m becoming a doctor.

14-15 hour days are long and exhausting.  Especially night shifts.  And it doesn’t help that I’ve already gotten myself sick.  I think it’s going to be very hard to take care of myself during residency.  I probably need to eat more and drink more water.  And eating bacon from the cafeteria every morning should probably not become a habit.

I don’t know how I’m going to make it through this.  It can be overwhelming at times when I don’t know what I’m doing and there are lots of sick patients to take care of and they’re all decompensating at the same time.  But it feels really good to have survived my first week as a doctor.  Now if I can just survive these scorpions…

First Day of Intern Year

The Scorpion

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The Doctor is In

The Doctor is In

In T-minus 3 days, I will see my first patient as a real doctor.  And I’ve never been more afraid in my whole life.  You would think with four years of college and four years of medical school I would be prepared for this, but I’ve never felt less prepared for anything.

I started orientation last week.  So far I’ve become great friends with all of my cointerns.  It’s fun to meet new people, especially since they share the same interest as me since they’ve chosen to go into Internal Medicine.  I can already tell that these are going to be some very important people in my life, and probably life-long friends.

I received my long white coat (which is way too big) and my badge that allows me to eat for free in the cafeteria and park in physician parking (which saves me a 5-minute walk in 120 degree heat).  I’ve listened to lots of talks about professionalism and dealing with specific situations that arise in practice.  I’ve downloaded almost a dozen apps onto my phone to help me look things up.  I’ve been recertified in basic and advanced life support and practiced lots of procedures on simulated manikins.  And I’m getting computer training tomorrow.  So I should be all set.  Right?!

The truth is, I’m scared out of my mind.  The same thought keeps popping into my mind.  What if I kill somebody?  And no matter how many people reassure me that won’t happen, I can’t shake that thought from my mind.

Probably doesn’t help that my first month will be spent in the ICU.  I remember my ICU rotation at this same hospital when a nurse told me she felt sorry for the poor interns who get placed in the ICU for their first rotation.  I guess it was a premonition.  To make matters worse, I am working my first weekend on nights in the ICU, which does not always have an attending in-house.  Luckily, I’ll have a senior resident supervising me, but I have this sinking feeling there will be a record number of Codes called, and I’ll be on my own.

And aside from first day jitters, I can’t help but feel scared for the entirety of residency.  I’m going to be working really long hours.  I’m not going to have nearly as much time as I’ve had as a student to spend with my family.  The thought of not even getting to see my daughter for 4 days at a time just gives me a sinking feeling in the pit of my stomach.  And deep down, I’m afraid that I just can’t do it.

I’m afraid I can’t be a doctor.  I’m afraid my marriage won’t be able to survive residency.  I’m afraid that my daughter will miss me and cry for me and I won’t be there.  I’m afraid that I’ve made a huge mistake.  That it’s all just too much.  That I’m not good enough to do it all.

But in 3 days it doesn’t matter.  Because I’m a doctor.  And I’ll have patients who depend on me.  And I just hope that I don’t let them down.  I hope that I can handle the pressure.  I trust that I’ve learned something in medical school and that I’m not completely unprepared to take care of my patients.  I just hope I don’t kill anybody.  One of the speakers during my orientation said it best, “You don’t get to be like everybody else anymore.  But not everybody gets to call themselves doctor.”

 

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Becoming a Doctor

It’s official.  I’m FINALLY  a doctor.  And, I’ve got to say, it’s pretty much exactly as I pictured it would be.  Now I can just relax and start cashing my giant paychecks.  I’ve basically just been too busy deciding what to do with all the fame and fortune that has been bestowed upon me to blog lately, so – apologies.

Riiiight.  But I really am a doctor.   And I feel pretty much the same as I did before graduation.  But now people jokingly call me Dr. Howard.  Well, half-joking, I guess because I’m actually a doctor, but…come on….I’m no more a doctor that I was a month ago.

Graduation was indeed a momentous occasion.  But it wasn’t a day I was particularly excited about.  I was excited to see my friends and classmates, many of whom I hadn’t seen in the past two years.  And I was excited to have my family come and see me walk across the stage.  But even after walking across the stage and moving my tassel from right to left, or left to right, or whichever way it is, nothing momentous really happened.  The diploma they handed me wasn’t even real.  I have yet to receive the real one in the mail.  (And with the hundreds of thousands of dollars I paid in tuition, I’m expecting it to be made out of gold.)

I’m not sure why I wasn’t that into graduation.  Maybe it’s because I wasn’t technically done with rotations until after graduation since I was behind from taking maternity leave.  Maybe it’s because I still have six years of training left and graduation doesn’t really feel like the end of anything.  But I think the real reason is that becoming a doctor doesn’t happen in a day.  It happens in a lifetime.  Becoming a doctor has been a journey that started almost 28 years ago.  And it’s one that will continue throughout my liftetime.

 

Following my graduation I traveled back to my hometown of Harvard, Nebraska to spend time with my family and attend my ten-year high school reunion.  I saw so many of my old teachers, neighbors, friends, and classmates.  So many of them were excited to see me and be one of the first to congratulate me and call me Dr. Howard.  I was overwhelmed with the unexpected multitude of people who knew I had just graduated because they have been reading my blog these past four years.

Many of you might not know it, but I grew up in a very small town of roughly a thousand people.  I graduated with a class of only twenty.  And only one or two other people that I know of have gone on to become doctors from my hometown.  And it never really occurred to me that me becoming a doctor was something that my whole town would be proud of.

And they should be.  Not because I’m some big shot doctor now.  But because the love, support, and example of my family, friends, and community are what shaped me into the doctor I am today.  These past four years of medical school might have taught me what I need to know in my career, but it takes more than knowing medicine to be a good doctor.  It takes love and hard-work, sacrifice and determination, empathy and compassion.  It takes kindness and humility.  There is so much more to being a doctor than medical school can teach you.  And that’s what I learned from my small town.

I’m sure you’ve heard the phrase: It takes a village to raise a child.  I think the same can be said for good doctors.  I wouldn’t be here today if it wasn’t for so, so many people who have helped me along the way.

For my family who has loved me and cared for my whole life.  For my teachers in elementary and high school who taught me how to read, how to write, how to calculate, and how to think.  For my classmates who taught me friendship and how to work as a team.  For my neighbors and church members who set amazing examples of me of what it means to be good, decent, and moral human beings.

So many people share in my success that it really seems wrong to think of my becoming a doctor as a feather in my own cap.  The reality is, becoming a doctor is what I was supposed to be.  It’s what everyone has worked so hard at helping me to become, and for me to become anything less would have meant letting all of those people down.

So, thank you.  To all of you.  Especially those who read this blog.  Your silent support by simply reading my stories is almost tangible at times.  To write and have my words be read is one of the biggest compliments I have ever received.  So I thank you.  I hope that this blog has lived up to your expectations.  As I hope that I have lived up to your expectations.  I will continue to write, as being a writer is also one of the things I must do with my life.  And I hope you will continue to read.

Graduation

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Life Lessons that Medical School has Taught Me

As my medical school education comes to a close, I find myself reflecting back on the last four years of my life and the things that I’ve learned.  I’ve learned a lot about medicine – how to diagnose and treat all kinds of diseases.  I’ve memorized countless pharmaceuticals, both generic and brand name, and their most common side effects.  I can recite CHADSvasc scores and TIMI risk calculations, which probably doesn’t mean much to you reading this.  But I have learned a lot of things that I didn’t expect to.  I’ve learned a number of lessons about life that I think I can pass on to everyone, even those who may never set foot in a hospital.

  1. You can’t know everything.  This is one of the hardest lessons I’ve learned as a medical student.  I went into medicine because I have a thirst for knowledge.  The more that I’ve learned, the less that I feel like I know.  But at some point you have to put the books down and say, Hey, I can’t know it all.  And that’s okay.  Just because you’re a doctor doesn’t mean you’re an expert at every aspect of medicine.  It means you’ve worked your butt off and you know a whole heck of a lot because of it, but at the end of the day, you’re still merely human.
  2. Know your limitations.  It’s hard for me to admit when I don’t know something, but the best physicians I’ve worked with are the ones who readily admit when they don’t know the answer.  Admitting you don’t know an answer is much better than guessing or making something up, especially when you’re dealing with people’s lives.
  3. You can’t do it all.  I’ve always thought of myself as superwoman (humble, I know).  But the last four years have taught me that you really can’t do it all.  I pride myself on being a wife, mother, writer, and now, doctor.  But it’s a lot to juggle, and I can only be in one place at once.  As much as I want to say that I can do it all, the reality is that every day I have to make tough choices about how I will spend my time.  That means choosing to work instead of stay home with my daughter or choosing to study instead of spend time with my husband.  Something always has to give.
  4. A little chaos is okay.  This is a lesson I try to remind myself of constantly.  I am a very neat and organized person, and having a toddler is a constant internal struggle for me.  My daughter enjoys making piles of things and making all kinds of messes around the house, and it takes a great amount of strength to watch her mess things up.  But at the end of the day, my daughter is having fun, and everything that gets messed up can be put back.  Or not.  Somebody will clean it up.
  5. You’re stronger than you think you are.  I’ve always believed that God never gives us more than we can handle.  But I also believe he gives us exactly as much as we can handle and never any less.  So, so many times during the last four years I’ve felt like quitting and giving up, but somehow I’ve pulled through.  I think we are all capable of much more than we give ourselves credit for.  Then again, we’ll see if I survive these next three years…
  6. Be thankful – it could be worse.  My patients are always reminding me that my life could be so much worse than it is.  I’ve seen children lose parents, parents lose their children, and spouses torn apart by death.  So many days I run home to my family and thank God that I’m so lucky.  No matter how bad things get, I try to remember that it could always be worse.
  7. Every day is a blessing.  Very similar to Number 6, but a lesson just the same.  We never know what tomorrow brings.  Today could very well be your last.  So carpe the heck out of this diem and remember that every day is a blessing.
  8. You can learn something from everyone.  Every person has a story, and every person is on this earth for a reason.  If you are able to spend time with them, talk to them, and figure out what that reason is, then you can learn something from everyone.
  9. Learn from your mistakes.  Every failure is an opportunity for growth.  If you make a mistake, learn from it.  Move on with your life, and don’t make the same mistake again.
  10. All bleeding stops eventually.  A common saying in medicine that basically means this too shall pass.  No matter how bad things get, they won’t be bad forever.  Some days you just have to get out of bed and put one foot in front of the other.  Then repeat.  Again and again until things get better.
  11. And last, but not least: Take care of yourself first.  Definitely my motto, aka I am My Own First Patient.  But this applies for everyone.  You can’t help others if you are a mess, so always take time for yourself when you need it – a little bit every day if you can.  Those around you will thank you for it.
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Married in Med School III

This past week my husband gave me a graduation gift.  He bought me a dress I had been wanting for my upcoming graduation.  I was so excited about the dress and really touched that he got me a gift.  But the truth is – he didn’t need to.  He really didn’t need to.  If anything, I should be giving him a graduation gift.

The past four years seem like they have gone by so fast.  But when I really think about it, these have been four of the longest years of my life.  The hardest years of my life.  And my husband has been there with me every single step of the way.  And however hard it has been for me, it’s been even tougher for him.

I’m the one who decided to be a doctor.  I’m the one who decided to go to medical school.  I’m the one that decided to take on hundreds of thousands of dollars of debt.  Not him.  And the craziest thing is, my husband has never held it against me.  Not even during out lowest moments.  Not even during our worst arguments.  There hasn’t been a single time that my husband has said, “Maybe you shouldn’t have gotten us into this mess.”

Even though I’ve thought it about a thousand times.  And I will probably continue to think that in the years to come.  My husband has been the biggest source of support and encouragement I’ve had during medical school.  And without him I wouldn’t have made it to this point.

He is the one who deserves a graduation gift.  But what do you give someone who has held your hand when you’ve lost a patient?  Someone who has listened to you talk about your day (over and over again) when he doesn’t really even understand what you’re talking about?  Someone who has held you as you cry when he has no idea why you are crying? Someone who has reminded you that you’re doing the right thing when you feel like you aren’t?  Someone who has let you follow your dreams no matter what the cost?

You don’t find a gift like that at the mall.  The truth is, there is absolutely nothing I can give my husband to repay him for everything he does for me.  We have been through so much during medical school.  There have been more ups and downs than I can count.  But we’re still standing.  And in many ways, I think the struggles have made us stronger.  I’m glad we went through this experience together.  I’m glad I have someone by my side to remind me why I signed up for this.  Someone to remind me who I am and where I’ve come from.

But who knows?  I might still find something.  Maybe they make t-shirts that say “Med School Survivor” or “Trust Me My Wife’s a Doctor” or something to that effect.

Best Husband in the World

My husband making breakfast, unloading the dishwasher, and taking care of our daughter on a Saturday morning while I slept in

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I Am My Own First Patient

I am my own first patient.

These are the words that inspired me to begin my journey as a med student blogger.  Four years later and  I’m still at it!  The time has flown since I received my acceptance letter to now, only a few weeks away from my graduation.  And as graduation approaches and I make the transition from student to resident, I can’t help but ask myself, how am I doing?  How is my first patient really doing?

It’s a difficult question to answer.  I’m alive.  I’m breathing.  Somehow I made it through.  But how am I really doing?

The truth is, when I look in the mirror I see a girl who is a shadow of her former self.  In good ways and in bad.  I’m not the same girl who started this blog four years ago.  I’m a different person.  I have a different outlook on life, a different outlook on everything.  The things I’ve learned and the things I’ve seen and the patients I’ve met have changed me.

I feel more jaded.  More alone.  I feel like I care less about others and more about myself.  I feel like I’ve forgotten many of the reasons why I wanted to become a doctor.  I’m less empathetic.  I listen less and speak more.  I curse more.  I am quicker to judge and less inclined to give the benefit of the doubt.  I read between the lines and often skip the dialogue.  I’m more determined and put up with less.  I cry less but have more nightmares.  I get more headaches but have less time to notice.  I have little patience and no time to waste.  I almost never read, and find less and less comfort in books.  I forget to eat and get sick often.  I’m homesick.  I am harder on myself than I used to be.   I go longer and longer without showering.  I can’t remember the last time I wore makeup.  No amount of sleep ever seems to be enough.   I’m tired of training, but am only halfway done.  I’ve sacrificed more than I thought I would and realize that more sacrifice is needed.

When I look in the mirror I want so badly to see the girl I used to be.  I want so badly to go back.  Just for a moment.  I want to meet that girl who thought she could conquer the world and save lives and have it all.  I want to ask her how to keep going, how to get back to that state of mind.  I want to be her again.  Or at least to know that she is still in there somewhere.  That I’m the same person that I used to be, just different.

It kind of reminds me of one of my favorite poems by Robert Frost, so I will share it with you.  Enjoy.

Into My Own

One of my wishes is that those dark trees,
So old and firm they scarcely show the breeze,
Were not, as ’twere, the merest mask of gloom,
But stretched away unto the edge of doom.

I should not be withheld but that some day
Into their vastness I should steal away,
Fearless of ever finding open land,
Or highway where the slow wheel pours the sand.

I do not see why I should e’er turn back,
Or those should not set forth upon my track
To overtake me, who should miss me here
And long to know if still I held them dear.

They would not find me changed from him they knew–
Only more sure of all I thought was true.

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