going with your gut

source

Great article on the all too easy, all too often assumptions we can make as physicians, and the consequences: Afraid to Speak Up to Medical Power (from the NYTimes), based off this NEJM submission

Noteable excerpt (on sending a patient to surgery who clearly wasn't well):

"We realize that, each of us unsure, we gained confidence from the perceived assurance and expertise of the other. We unearth the other specialists who participated in the patient's care...The general internist bowed to the others, and the surgeon was approached as the next service provider in line. Tragically, no one person looked beyond the effusion to the whole patient. Although he saw myriad specialists in his last week of life, he died lacking holistic care"

Conclusion:

"...In a profession abounding with experts, no one person's expertise can always count for more. Although certain technical skills may be specialty-specific, there's a much broader range of skills on which no group has a monopoly. There's no chain of command in using gut instinct, showing concern for the whole patient, avoiding harm, or curtailing futile care. We must recognize that debate is healthy and that without open communication, we fill the space by guessing at each other's motives."

Lesson? Speak up and go with your gut. If all else fails, at least you'll learn something.

And again, more reasons to count blessings

Boston marathon coverage from NY Daily News

Working in the medical profession, particularly in acute-care settings, has definitely changed my perspective of natural disasters and the recovery from devastation. Every time I head about explosions, disasters, bombings, etc, my mind has learned to reflexively think about the emergency/disaster medical teams that must mobilize so quickly and try to save as many people as possible. I can only imagine the chaos amidst fear and confusion and trying to be the face of calm, trying to think straight during those times so you can prevent more destruction...man...

Part of me wants to be in on the action, to be there to help, save people, and protect lives. After all, that's what I'm being trained to do now, isn't it? However, it's a fine balance between getting to do a lot and also sacrificing my own personal safety (I tend to disregard that a lot...heh).

My friend posted up this story from WWII as similar to this story from this week about a fortunate man who escaped TWO destructive events very narrowly. I read Hiroshima by John Hersey back in high school, but I think at the time I was not experienced enough to appreciate the devastation that was caused by the atomic bombs. I did not understand fear or human pain. Part of it was because I feel like as humans, we want to avoid feeling pain. We want to avoid causing ourselves more emotional stress than is necessary, so we block those feelings and distance ourselves.

3rd year has taught me that pain will come, and HAS to come, to grow us. And I no longer run from pain--I embrace it (more on this later). I am thankful for the experiences in my life so far because they have slowly opened my eyes to depth of pain people can suffer and the strength of human resilience. Look at the people in war torn countries right NOW...they go through bombings and attacks everyday. Referencing back to my previous post we are SO lucky to be in a country that is LARGELY safe. Safety is NEVER guarenteed, but with Christ, PEACE is. <3

counting blessings

The incredible and wonderful acts of kindness people performed after the events in Boston today were incredibly touching, but even more so because it brought such a contrast to the stories I hear from refugees who find their new homes here in the US everyday. I am SO incredibly thankful we are in a country where there is an ABUNDANCE of helpers...a gift many places in the world do not have. 

A patient the other day came in as a new patient; we soon found out he was a refugee. After having been imprisoned multiple times for speaking out against the government, finally forced to flee his country because of persecution, with nothing but the shoes on his feet and the clothes on his back, he went into a neighboring country with no contacts, no friends, no helpers. Through pure resilience, a wary heart and the kindness of a handful of strangers, he made it through. However, he left his then-infant son back in his country, and has not talked to him in more than a decade. If he ever gets to meet his son, his son will have already become a grown man... without his father.

How many of us would have made it through without the abundance, the COMFORT, that comes from knowing we are in MULTIPLE good hands? Such is a luxury we take for granted here in the US, where generosity is welcome, praised, and encouraged.

It is not the case in other places.  

Again and again, I am reminded of what a blessing Urbana was for me. As one of the speakers said: 
'Our problem, the reason we are so unhappy and disatisfied in our first world lives is because we have given ourselves a sense of ENTITLEMENT. As mere mortals, we are not entitled to ANYTHING. But we have such a merciful God who is willing to bless us with gifts...and we can combat our dissatisfaction with being thankful everyday for the things He has given us.

Tonight, my prayers go out to Boston, both the victims and the helpers. God, please calm their hearts, show them how good you are, and give wisdom to those who are still helping. But also, my prayers go out to those suffering in the dark places, who have learned to deal with this kind of thing as commonplace. There is so much sin in this world. God, more than anything, comfort them.
----

inspiration #?

I like to post links to people I admire, so I have a reference later on for who I might want to emulate.

Example:
Dr. Fagenholz
Spent "[first 3 years doing general surgery residency. then next 2 years] he was a research fellow...studying the epidemiology of surgical diseases such as pancreatitis and burn injury as well as the physiology of hypoxia and high altitude illness.  His high altitude work led him to Nepal where he performed field work in the Khumbu Valley and met his wife Alice, an emergency medicine physician.  Dr. Fagenholz then returned ...completing his residency in General Surgery....

In addition to his travel to Nepal, Dr. Fagenholz has also worked with Partners in Health performing and teaching surgery at Butaro Hospital in Rwanda (http://www.pih.org/pages/butaro-hospital) and is currently invovled in international surgical development through the Program in Global Surgery and Social Change at Harvard Medical School (http://ghsm.hms.harvard.edu/uploads/pdf/global_surgery_3.pdf).


This guy is AWESOME!! His story ignites more frustrations on whether oncology should really be the field I want to pursue if I want to go into international work (though, there definitely is a hole there. which means lots of new research upcoming on prevention and cost juggling!). OB/GYN?? EM???? probs not surgery, though so cool!! :)

reasons why NYC is awesome

Did I ever mention the sax and cello are my favorite instruments ever? If you can play either, you definitely have a piece of my heart ;)

so this is the outpatient side...!

Having done very little outpatient work during 3rd year so far (except for like 3 days on OB/GYN), it has come to my attention that as a student, you are much busier in the outpatient than inpatient setting. This is because:

1) Patients in the hospital are not going anywhere, nor do you need to wait for them, so you really can see them whenever you are able. Basically, you can manage your time. If you really wanted, you could spend an hour on one patient. On the contrary, in clinic, you have a set schedule, so once you're done with one patient, another one is waiting for you, and your time is limited. I had more time on the floors to use the bathroom than I had in clinic today.

2) On the floors, you were assigned certain patients out of a whole list of patients. In the office, you see EVERYONE (or at least, every other o_O).

3) If each patient's visit goes a bit longer than is scheduled, you are no ddoubt going to be 'late'. There is no real concept of 'late' on the floors. I had enough time to think and formulate a plan on the wards...that definitely did not happen today.

However, my school's family medicine department is PHENOMENAL. Sometimes I feel like the physicians there know loads more than the hospitalists, because their knowledge is 1) broader in scope and 2) more applicable and realistic. Most people are healthy but need checkups. Also, it is usually a PCP that sees a patient's first presenting signs of any illness. I know this might not hold true for all family medicine departments, but props! :)

The Medscape report I posted about in the previous entry comments on how PCP's are the physicians who most complain about underpayment. After today, I couldn't agree more. Specialists have their job almost handed to them--usually the HPI is already taken, you order some tests that only you can order but don't compensate you back THAT much...you have one area where only so many things can go wrong...on the contrary, the PCP does a lot of the heavy lifting. Honestly, I feel like specialists who get paid the big bucks like cards and GI do so because of their procedures. But family medicine doctors do procedures too! In big academic centers and cities, primary care doctors are grossly underrated. They are THE doctors, THE lifeline, in low resource/rural settings.

 I dunno...this is only my first day on family medicine and already I am both overwhelmed and in awe. It doesn't help that my preceptor has high expectations. Did I mention I'm working directly with an attending?? (but who happens to only be like...in his early 30s?!)

With this year off, if I choose to do onc, I'll be...25 when I graduate medical school. 28 when I finish IM. 31 when I finish my onc fellowship. I keep forgetting that fellows are pretty much attendings. But for those who only have like 3-4 years of residency training, and them WHAM you're an attending--i.e. EM, peds, family med, hospitalists or IM generalists, PM&R, OB/Gyn, neuro, ophtho...basically most things if you don't specialize...some of my medical school CLASSMATES are older than some of the newer attendings. That blows my mind. Especially since 30 is like the new 20s.

That, and I feel like I have friends who range from 23-31. So technically I could be peers with an attending o__O

#candleswithoutapowerouttage

I am fortunate to have family medicine and pediatrics to end my 3rd year...two rotations that are supposedly less time-intensive than all the other clerkships. Therefore, let this be a testament that in the next (and last!) 3 months, I will make it a priority to:

1) Write at least 3 times a week, because there are so many stories still untold, many memories needing reflection, and I want to capture them before they disappear into the abyssmal space that is my 'life' in the midst of my medical training
2) Take care of myself both in food and exercise, because now I can't really blame my schedule or the weather on my lack of activity :P
3) Study for step 2!!!

Random note:
Yesterday, I decided to be completely spontaneous and 'study' by candlelight. It wasn't exactly an attempt to be eco-friendly, since I was studying on my laptop (haha the irony), but there is something about the flickering of the small flame and the orangy-glow you get from the candle that creates such a calming ambiance.

My desk last night :)

I swear, I study normally 98% of the time! But honestly, who wants to be normal that long? I love unique people because I truly believe they add spice to life. And I fully embrace my weirdness :)

To add to my bucket list:
[ ] spend a night with someone (friend, family, future significant other?) only by candlelight, and talk until the candles burn completely out :)