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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Neuro ICU

Things I’ve Learned This Month

  1. Don’t ride a motorcycle without a helmet.
  2. Don’t ride a motorcycle even if you have a helmet.
  3. Just don’t ride a motorcycle.
  4. Alcohol and guns don’t mix.
  5. Russian Roulette is never a good idea.
  6. Think twice before you tattoo something on your body.
  7. Even if you’re not an alcoholic, one night of drinking too much could kill you.
  8. Tell the ones you love how much you love them before it’s too late.
  9. Make a living will.  Save your loved ones the stress of trying to decide what you would’ve wanted when you can’t tell them.
  10. Tomorrow is guaranteed to no one.
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Match Day

Last Friday was “Match Day.”  It’s the day every year when all medical students find out where they will be going for residency.  Kind of a big deal.  And it’s a very complicated process that no matter how many times I explain it to people, they don’t really understand.  So I’m about to break it down for you.

There are technically three “matches” that an Osteopathic medical student can enter.  The first match takes place in December and is only for military students.  The second, and most common, is the DO match, which is specific for Osteopathic students.  The third is the Allopathic match, which is open to all students – Allopathic, Osteopathic, and International/Foreign graduates.  DO students can choose the DO Match, the Allopathic Match, or both.

In fall of the fourth year of medical school, students apply to residencies, start going to interviews, and do audition rotations with programs they are interested in.  Then they submit a Rank list of their top programs.  Residency programs submit their own rank lists of applicants who interviewed and it all goes into a computer system.  The system is designed to rank as many students into their top choice programs as possible.  Then when Match Day comes around, everyone finds out where they are headed for the next 3-5 years of their life – whether they like it or not.

It’s very nerve-wracking as a student because you could technically match to any program on your rank list, or to go “unmatched.”  Going unmatched is a medical student’s worst nightmare.  If you don’t match into any program on your rank list you enter into the “scramble,” which is exactly what it sounds like.  You scramble trying to find any program that has an open spot and that will accept you.  Not ideal.

In my case I chose to enter the Allopathic Match based on my top choice programs here in Phoenix who are in that Match.  I applied to 24 programs for Categorical Internal Medicine.  I got 14 interviews and went to 8 of them.  I ranked 8 schools.  I matched at my #2 choice which is Maricopa Medical Center here in Phoenix, Arizona.  And I am very pleased with how things turned out.

It is such a relief to be on the other side of the Match.  I know most of my friends and I were nervous for months and months about getting interviews and going to interviews and submitting our rank lists and finding out where we would be going.  It’s not an easy process by any means.  But I’m so proud of all of my friends and classmates.  We had a huge success in the Match this year, and I’ve enjoyed seeing where everyone is ending up.

It’s so crazy to think that we are all actually going to be doctors.  I still remember day one of medical school and how we would try to predict what people would go into.   Certain personalities fit with certain specialties, and now that everyone has decided it makes so much sense.  Hopefully Internal Medicine makes sense for me.  I still think it does.

So what happens now?  Well – basically, I’m a doctor.  I sign my contract and I start on June 23!  Crazy.  But exciting.  Since we get to stay in Phoenix, my husband can continue working as a flight instructor as he continues to build up his flight hours to apply to an airline.  He is in the process of trying to figure out which airline he wants to fly with.  Even though we are staying in the same city, we are planning to move to a bigger house.  The bigger Anika gets the smaller our current apartment feels!  And now I can relax and finish my last two rotations of medical school before I graduate!

It’s scary to think that in a few months that I’ll be an Intern seeing patients.  But last week I saw a record 16 patients on my Neuro ICU rotation, and as my attending says, I’m going to have no problem keeping up during intern year.  Hopefully he’s right.  Either way, I’m ready!

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Coma

This month I’m on Neuro ICU.  For those of you who don’t know exactly what that is, I am working with a Neurointensivist who specializes in neurological disorders in a critical care setting.  The majority of our patients have either suffered a stroke or a traumatic brain injury.  Some are in induced comas following cardiac arrest.  And some have other neurological trauma, such as decreased strength or sensation in an arm or leg.

For starters, I LOVE being back in the ICU.  Neuro Critical Care is very different than Pulmonary Critical Care, which is what I’m hoping to go into, and we have a lot of patients who have suffered from trauma – aka car crashes or motorcycle accidents without wearing a helmet, etc.  I’m not a big fan of trauma care, but the neurological part of brain injuries is very interesting to me.

Many of our patients are in a coma – either from their accident or an induced coma for their own brain protection.  As weird as it sounds, I really like patients who are intubated and in a coma.  I love the detective work involved in their care.  They say that 70% of a diagnosis can be made based on the history taken from the patient.  Another 20% comes from the physical exam.  And the last 10% is from labs and imaging.  In patients who can’t talk to you, you’re really only left with the last 30% of the puzzle, and I find that I really like the added challenge.

However, not everybody wakes up from a coma.  And that is really hard.  Many patients have loving and dedicated family members at their bedside and you can see them clinging to any scrap of hope.  In many cases there really is none, and it breaks my heart that they don’t yet realize their loved one isn’t going to wake up.  I often envision my own family members in that hospital bed and try to imagine how that would feel.  Then I start to get teary eyed and have to stop.  In the end I realize it must just be terrible to see someone you love in such a state.

But there are some success stories.  Last week I was able to go with my attending to see a patient who was on the floor.  She had been an ICU patient several months ago after a bad car accident and was in a coma for over a month.  The doctor introduced himself because she obviously didn’t remember him.  But she was doing so fantastic, and I could see how gratifying it was for my physician to see how well she was doing.  Such an amazing success story.

I’m only a week into this rotation, but I’m really loving it, and I’m learning a lot.  There are always exciting things happening in the ICU.  For instance, last week a patient had explosive diarrhea and I was only a few inches away from getting hit!  So, so glad I didn’t get hit.  Should be a fun month if I can continue to avoid getting hit with poop.  And then only 2 more rotations before I’m DONE with medical school.  Is it too soon to start counting the days!?  (…68)

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Calling Dr. Howard, Dr. Fine, Dr. Howard

I was recently in the hospital when I heard someone mention calling Dr. Howard.  They weren’t referring to me, of course, but to a real doctor with the same name.  But at that moment it hit me.  In a few months, I’m going to be Dr. Howard.

I don’t feel like a Dr. Howard, much like I didn’t feel like Mrs. Howard after my wedding.  It took forever for me to remember to write my new last name, and even longer to remember that my initials had changed.  For those of you who don’t know me personally, my last name used to be Chloupek.  I liked being a Chloupek.  I felt like Emily Chloupek was a good name and really suited me.  It served me well for 22 years.

Of course, now my name is Emily Elizabeth Howard, (the same exact name as the little girl in Clifford the Big Red Dog), and it seems to suit me as well.  But making the jump to Dr. Howard has me a little on edge.

I’ve wanted to be a doctor for as long as I can remember.  At one point I remember practicing how I would sign my name.  (I give up, it’s not going to be legible.)  I only have two months left as Emily Elizabeth Howard.  In two months, nobody will ask for Emily, they will ask for Dr. Howard.  I feel like 99% of the time people will be expecting me to be man – not just becuase that’s a common assumption of doctors, but because Howard just sounds like a man’s name.

And then I’ll show up.  This short little blonde girl who has the same name as the little girl in Clifford the Big Red Dog.  And somehow, I’m supposed to be a “Dr.”  In many ways, I feel like it’s going to be a long time before anybody really believes I’m a doctor, much like how I still get carded when I try to buy cough syrup.

And I think it’s going to be a long time before I don’t feel like an imposter.  Before the “Dr” before my name doesn’t sound sarcastic.  I’ve always looked up to doctors.  It’s a profession I have great respect for, and it’s a group of people who I don’t feel worthy enough to be a part of.  Being Dr. Howard is going to a very humbling (and probably at times, humiliating) experience.  And I truly don’t feel worthy of such a title.

So I will leave you with a short clip from The Three Stooges which I think is incredibly fitting for this post.  🙂

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Cancer

This month I’m on “Hem/Onc,” aka Hematology and Oncology aka blood disorders and cancer.  A long, long time ago I really thought I wanted to go into Pediatric Oncology.  I slowly realized I didn’t want to work with kids or be depressed all the time.  But, surprisingly, I’m loving this rotation!

Hem/Onc is an interesting specialty because you get to form some really amazing relationships with patients.  Cancer survivors are eternally grateful to their oncologists, and their follow-up visits are very exciting times for both the patient and the physician.  I’ve never received so many gifts from patients in my life!

And some of these patients have the most amazing stories.  Just yesterday I spent over half an hour talking to a woman finishing chemotherapy for breast cancer.  She had formed bonds with all the nurses and patients on her inpatient floor.  But she was oh-so-excited to get to return to her home, which she hasn’t been back to in over six months!  She had her bags packed and just wanted to “okay” from her oncologist to leave the hospital.  She had such a sense of humor and joy about life…it was almost infectious!

But not every patient is a success story.  I’ve seen many patients who walk into the room and are clearly dying.  They are wasting away.  Many of them weigh less than I do and are just struggling through chemotherapy because if they stop, they will die.  And that is hard to handle for me.  Especially when they come with their spouses or children, and it’s very clear they have something to live for.

I think I could be happy being an oncologist.  As my attending tells me every day, “It takes a special person.”  But despite his persistence in telling me I need to be an oncologist, I really don’t think that will end up happening.  I love talking with patients and listening to their stories, and Hem/Onc is a great specialty for that.  But my heart drops every time I review the most recent imaging and see new metastases or growth of a tumor.  I hate delivery bad news to patients, especially when they’re so hopeful for a cure.

God bless all the Hem/Onc doctors out there because it isn’t an easy job.  Not only does it require a vast knowledge about cancers of the entire body and complex chemotherapy drugs, it requires a big heart and a lot of guts.  It’s difficult to tell someone they have cancer.  It’s even harder to tell someone they’re going to die.  But somehow they do it, again and again, every day.  Wow.

I hug my husband and my daughter a little tighter when I get home these days.  If nothing else, this month has been a good reminder of how much I take for granted.  Here’s are a few new pictures of my little girl – 19 months old and I can’t believe how big she is getting!

Anika's Surprised Face

Enjoying the Phoenix Weather

On Her First Hike

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Not Enough

There are days where I feel like I am superwoman.  Like I can do it all.  I can be an amazing physician and an amazing mother and still come home and put an amazing meal on the table for my family.  I feel like I can do anything.

And then there are days where I feel like such a failure – at medicine, at motherhood, at marriage, at everything.  I feel like I can’t do it all – like I can’t do anything, really.

Those are usually the days where my daughter is the first to be dropped off at daycare and the last to be picked up.  Those are the days where the only quality time I get to spend with her is putting her clothes on in the morning and taking them off for bedtime.  And those are the days where the fear creeps in.

The fear that I’m not enough for her.

What if some day in the future she looks at me and says, “Mom, you weren’t there enough.  You missed too many things.”?  What if she resents me for having a career?  What if she wishes she had a different mom – a mom who stayed home, who could come to every recital and every basketball game and every speech meet?

And what if she’s right?  What if I’m not enough?

I think that maybe the only thing scarier than that is if she thinks that she wasn’t enough.  What if she thinks I became a physician because being her mom wasn’t enough for me – that she wasn’t enough for me?

What if someday she finally figures out just how selfish I am?  I knew being a physician and a mother would mean missing things.  I knew I wouldn’t be able to come to field trips and bring treats for class parties and host play dates with the other kids’ moms.  But I did it anyway.

I can’t escape these thoughts.  But I hope I’m wrong.    I hope that she can see just how much being her mother means to me and how I wouldn’t give that up for a million years of being a physician.  And I hope she knows that even when I’m not there, she is still with me.  She is in my thoughts and on my mind.  She is the face I see during the day when I can’t wait to get home.  She is a part of me.  The sacrifices that I make are sacrifices that she makes.  And she shares in the lives that I touch and the work that I do.  I just hope she knows that.

One of my favorite poems of all time by ee cummings sums it up.  For this Valentine’s Day, I’m giving a children’s book adaptation of this poem to Anika.  She might not understand the words now, but I hope someday she will understand.

[i carry your heart with me(i carry it in]

by ee cummings
i carry your heart with me(i carry it in
my heart)i am never without it(anywhere
i go you go,my dear;and whatever is done
by only me is your doing,my darling)
                                                      i fear
no fate(for you are my fate,my sweet)i want
no world(for beautiful you are my world,my true)
and it’s you are whatever a moon has always meant
and whatever a sun will always sing is you
here is the deepest secret nobody knows
(here is the root of the root and the bud of the bud
and the sky of the sky of a tree called life;which grows
higher than soul can hope or mind can hide)
and this is the wonder that’s keeping the stars apart
i carry your heart(i carry it in my heart)
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Words of Wisdom

In two years of rotations I have had a lot of different attendings, and I have gotten a lot of difference advice.  Most attendings have a catch phrase or some sort of lesson they really want to impart on their students.  Some of their words I’ve forgotten.  But some have stuck in my mind.  I thought I would share the ones I can remember with you.  They might not seem that meaningful to you, especially taken out of context, but they’re meaningful to me, and I hope I don’t forget them.

 

“Nobody understands a doctor’s life like another doctor.”

“A physician’s two best friends are experience and humility.”

“It’s just like they say on an airplane – you have to secure your mask first before assisting your neighbor.”

“Recognize that when you see a patient, you are the smartest person in the room – so you should also be the nicest.”

“There will always be another patient to take care of.”

“Well, we can’t save the world.”

“…not good.”

“Anybody can look something up on Google.  We’re doctors.  We have to know more than Google.”

“You can’t kill a dead person.”

“Don’t ever be afraid to touch a patient.  Don’t ever be afraid to do something to a patient.”

“Life is precious.”

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National Women Physicians Day

Elizabeth Blackwell

“Let’s celebrate this upcoming February 3. It is the birthday of Elizabeth Blackwell, the first woman to receive an M.D. from an American medical school in 1849. She is best known for her tireless support of medical education for women and her public reform work. It is also the day that the Physicians Mom Group (PMG), a non-profit organization of almost 50,000 women, is declaring National Women Physicians Day. This day would celebrate all the significant contributions that women physicians make daily, none of which would have been possible without Elizabeth Blackwell.”

Here is a link to the rest of the article by Dr. Vanita Braver entitled, “Happy Birthday Elizabeth Blackwell: The ABCs of Extraordinary Women Physicians.”

Happy National Women Physicians Day!

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No Words

Everything will be alright.

It’s one of those phrases people say in times of difficulty.  They might touch your hand as they say it to help you believe them.  It’s a phrase I’ve heard coming out of my own mouth from time to time.  Sometimes to a friend.  Sometimes to a stranger.  But it’s a phrase that isn’t always applicable.

I recently lost a patient.  He was young.  Too young.  He had a ruptured aortic aneurysm.  His son saw it happen.  His dad called for help before he slumped to the floor.  They rushed him to the hospital, where I met him and his mother at the bedside of my patient.  They were all praying together.  A prayer I was familiar with.

The nurses and doctors were frantically getting IVs started, ordering blood, calling the surgeon.  Everyone did everything they could.  And there I was.  Just standing there.  Nothing for me to do.  And I looked across the bed at the patient’s family.  I wanted to tell them that everything will be alright.  But I couldn’t.  Because I knew it was a lie.  There were no words I could say in that moment.

Later that day the patient died.  And I couldn’t help but get angry.  He was too young to die.  He had no warning.  He had a family.  It wasn’t fair.  It wasn’t alright.

These situations are the worst in medicine.  I can kind of justify things in my mind if a little old lady dies at the ripe old age or 95.  She was old and old people die.  I can kind of justify it when the drug addict overdoses and then drives his car into a tree.  He brought this on himself.  He did something that caused his death.

But when a young patient drops dead out of nowhere, having done nothing wrong – it just doesn’t sit well with me.  And that patient’s death didn’t sit well with me.

Neither did the death of a young mother of three who dropped dead of a brain bleed a few days before.   As we told her husband that she was brain-dead, I wanted to say that everything will be alright.  But it wouldn’t.  It wasn’t fair.  And there were no words that I could say that would make it okay.

Because sometimes there are no words.

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