Endings and beginnings

So this is probably the best time to drop a word back in here. I finished my USMLE Step 1 test. I get my score back tomorrow. If I feel motivated, I might write a post or two about that experience. A quick summary on my second year of medical school and the end of preclerkships: I’m surprised how much I learned in so little time. But I’m even more impressed with what I don’t know because wow, you can really spend a lifetime learning medicine.

In two weeks, I will be hauling a pager, struggling with EPIC, furiously reading, and most scarily — taking care of patients. My first rotation is pediatrics. I am nervous for a few reasons. To start, it so happens that the hospital I am rotating at was exactly where I was hospitalized (and as a pediatric patient to boot!). I’m not quite sure how I will be handling that situation. Right now, I think I will be okay (by the way, my doctor is finally taking me off my last medication!), but who knows how I will feel when I see an equally sick child on the bed? And as excited as I am to finally “get to be a doctor” (not really as I am still a few years out from my MD), I can’t help but feel SO nervous. The immense responsibility of having someone else’s life in your hands… I mean, wow. One can say that at least I’m lucky to be starting on pediatrics since children are generally a more resistant folk (emphasis on generally), and the pediatricians are known to be incredibly supportive and great teachers. Our deans this week have been throwing at our face that from now on, our time is no longer our time, it is our patients’ time. And I’m okay with that. In fact, in a weird way I am looking forward to not having to think about myself and focus on someone else (that’s probably not psychologically healthy but I don’t care). I’m just worried… what if I can’t do enough? What if I mess up? What if I don’t know things?  It’s a little funny to me because I wrote about this exactly in one of my secondary essays when I was applying to medical school. The prompt was something to do with asking us what we thought our biggest challenge would be, and I said it was learning to accept that patient outcomes and healthcare in general are not entirely in our hands. I said back then that I hoped my colleagues and teachers would prepare me for this struggle, and I think I am better, for sure, but it will be a battle I will have to keep fighting. I hope I am good enough for my patients.

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Smoking Cessation

I’ll be one of the first to admit that I tend to have absolutely no sympathy with smokers, judge them very harshly, and I’m just all around very rude and not understanding to them. I realized this was going to be a problem when I was shadowing in cardiothoracic surgery a few years ago because, well, there’s just a ton of patients I’ll get who will be smokers, and as their doctor, I can’t be nasty with them. So I always knew this would be difficult. Our first week in the pulm unit, we had a class on smoking cessation beginning with a patient presentation. I remember thinking that when they told us they’d bring in a smoker, I was very disgruntled, wondering what a smoker had to offer to a presentation when it’s really easy to find a smoker. What new information would this person provide?

Well, she was a quitter. And I guess that didn’t do much for me at first, but the more I listened to her talk, the more I realized how wrong I am/was about smokers. Granted, smoking is still terrible for your health. And you still should not start it. But I guess I always just approached the quitting part in a way that wasn’t conducive to anyone quitting at all, which makes me think back to a bunch of people I “defriended” because of their smoking habits. One of my classmates asked our patient what it feels like to try to quit, what a nicotine craving really is like, and she couldn’t really tell us except that she just wanted to smoke whenever she needed to cope with something stressful. I’m sure I’ve heard something like that before but this time my perspective changed. Maybe it’s because I’ve started to realize more of my own unhealthy coping mechanisms, but in that moment I suddenly felt a big burst of empathy for smokers (I know, I can’t believe I’m saying that too). It’s really hard when you’re in that moment to try to convince yourself out of your unhealthy habit — you know it’s irrational, you know it’s unhealthy, you know that in any other normal state of mind you wouldn’t want to do this, and yet you still do. I’ve struggled with my own demons for years, and it’s HARD. Even now, after seeing a psychiatrist and therapist, I still have my relapse days. And as we learned in psych, mine is based on neural circuits that I’ve ingrained since I was a child. So how different is that really from the smoker whose own neural pathway is also messed up, telling him/her to just get that burst of relief and calmness and happiness from the cigarette?

So I’m glad I actually had that interview in the end. Next week we’re supposed to practice motivational interviewing, something I was initially dreading because I didn’t think I could pull off acting sympathy. Well now I know I won’t have to because I really do get it, I think. And I’m glad that I’m learning more about what it feels like to be the patient (hah, as if I don’t have enough experience with that).

M2

Something happened in the past few weeks that finally made me realize that I’m actually about to be a doctor. I don’t know what it was; perhaps it was wrapping up the cardiovascular system, which happens to cover most of America’s healthcare problems in a compressed bursting-at-the-seams 4 week package. It could also be because we got our clerkship schedules for the coming year (I got plastics and ENT for my surgical subs, which I’m extremely happy and excited for!). It could be actually being able to read an EKG, knowing what treatments to give someone who’s going through a heart attack, being able to hear and identify a murmur. It could’ve been that I had to teach some of the lay public how to do the cranial nerve exam. Something happened, and it finally occurred to me that I really am not just a student going through the motions, but I’m actually almost a doctor. Wow.