If you don’t have anything to say, reasonably you shouldn’t force saying something. Yet most of the time, when we’re in the presence of others, silence compels us to make small talk or ask a decisive question to break the ice.
On the other hand, when I’m alone with my thoughts a lot goes through my head, but when it comes to writing sometimes, I draw a blank if there’s no prompt.
Back in my sophomore year of high school, my chemistry teacher (definitely one of my favorite teachers of all time) had us write “letters” to ourselves that he would mail out to us in 10 years. They were more like forms that we filled out with questions about our life at the time and with introspective prompts.
It’s been interesting reading through it and seeing what was going on 16-year-old Niko’s head. There’s definitely a lot of things that I remember writing or perspectives I remember I having that are captured in the letter, but there’s also a lot in it that I had forgotten about.
At this point, I guess I was thinking of going into academia and being a college professor. I remembered being a bit jaded at the time and plagued by feelings of inadequacy, but I wasn’t expecting the extent to which it would be reflected in this letter.
When prompted to describe myself, the first sentence I wrote was, “I have short brown hair and am always tired,” followed by some normal stuff about my hobbies and things that I apparently hated. And I end the paragraph with, “Honestly, I could be making 10x smarter decisions then I do.”
For the section that asked, What things are you good at? The only thing written down was, “Procrastinating.”
What is your biggest fear right now?
“Failure, rejection, not being good enough, living in fear”
Reading all this kind of made my sad for my teenage self, and I do remember what it was like for me back then and some of the feelings and experiences I had through high school that really prompted a lot of that. A lot of the things I wrote actually still apply; the difference is now I have grown to be more compassionate towards myself and have developed practices for dealing with though feeling and fears. Also, perhaps paradoxically, I am less tired these days than I was then.
There were some rays of hope for young Niko in the letter; signs that I wasn’t just a puddle of self-doubt and pity.
What kind of person have you dreamed of becoming?
“I want to be a person who is just like the person my dog thinks I am.” Pretty sure I stole that from somewhere. “I want to be able to look back on these 10 years (and hopefully future years) [yes, I apparently loved obnoxiously using paratheses back then too] knowing I loved unbridled by fear, but also within my morals and the ideals of my family.”
What is the best advice you could give yourself in ten years from now?
“Do what you love. Play music, have fun, smile… Don’t lose your character and appreciate everything, small and large (you/ I need to work on that now). Be awesome.”
I also put a $10 bill in with the letter, probably in hopes that there would be some sort of cataclysmic economic crisis and that this bill would be worth millions in the 10 years that it was stored away. Though I think the reason I put it in there was so that the present me would have a nice surprise, except I never fully forgot that I wrote this thing and the fact that I put $10 in it was one of the things that I knew I could expect for sure, and I would think about it every time I thought about the letter.
All in all, it’s been fun to read through and a good chance to reflect on who I was and who I’ve become. My life is pretty different from what I probably envisioned at the time (I know I for sure did not want to be a doctor back then), but I think that if 16-year-old me could see where he would be mentally and situationally in 10 years it would put him at ease, at least just a little bit. We’re gettin there.
I was able to leave the virtual symposium a little early today to join my attending for the surgery. Some of the research topics were kinda interesting though. The first was a guest speaker who was talking about essentially how to improve the teacher student feedback dynamic. I was itching to have my first operating room experience, so it was kinda hard to stay focused with the others.
Fast forward to being at the hospital. I had some difficulty finding the main operating room, which is where I was supposed to meet him. Luckily a nice doctor was able to guide me. Got there a little early, he was still coming from clinic, so just was standing around in front of the entrance and people kept asking me if I knew where I was going. He eventually showed up and we went in to check-in with the patient before the surgery. Then we went to the physician lounge for some lunch where I finally got to try the clam chowder which was reportedly pretty good. We finished up and went back to the OR.
This was my first time scrubbing in and it showed very hard. Washing my hands I was fine. Back when I volunteered in the NICU I used to have to wash my hands for 3 whole minutes before starting my shift with the scrubby sponges. I realized my attending didn’t dry his hands so followed his lead and entered the OR behind them. Immediately we told not to put my arms down, even though they already were, so I had to go back out and re-wash. Damn I knew that one too. I received a few other urgent warnings about different stuff until I was just standing off a bit to the side trying to stay sterile until we were ready to start. It was embarrassing, but luckily everyone was pretty nice and patient with me.
During the surgery itself I slowly eased into the rules and what was and wasn’t allowed. I got to help out at different points in what little ways I could, holding things in place, cleaning ports, controlling the camera. The whole procedure was fascinating and it was cool seeing in person what I had previously only seen on YouTube. The machine that was used to cut and cauterize made noises reminiscent of a casino or arcade which I thought was kinda funny. It was often easy to forget that there was a whole life human being on the table in front of us.
The hour plus we spent in the OR went by pretty quick and soon my first surgical experience was done. It was far from smooth, at least on my part, but I learned a lot and went 1 for 2 on pimping questions. Looking forward to the next one.
It’s funny that I was talking about physician wellness and stuff yesterday. Today while on our way to check on a patient in labor at the hospital, my attending and I got into a conversation about that very topic. He acknowledged that the days after his call shifts aren’t great and that he isn’t at his best and he told me to consider the possibility of call-shifts being a part of the rest of my life when choosing a specialty. We talked a bit about wellness and how students and younger doctors seem to, and are able to, put more emphasis on personal wellbeing, whereas for his generation it was all about the work, and he agrees that things are moving in a better direction. (Sometimes I’m concerned he somehow found this website and is reading what I’m writing, but also we did have a conversation yesterday about what it means to be happy and how some TED Talks approached that question, which good have in part prompted this).
On the way back from the hospital he asked me about what I did in my gap years. He was particularly interested in my work in street medicine, and we got into a conversation about homelessness, and he asked what I thought the solution was. Obviously, I didn’t have a good answer for him, but I gave my thoughts.
Pretty standard clinic day. It is nice to see some of the patients who are later in their pregnancies so I’m seeing them for the second or third time already. I still feel like I’m learning a lot every day which I guess is a good thing, but also shows how little I knew coming into this.
We did have one delivery in the evening. It was a long labor, but thankfully the patient was eventually able to deliver, though maybe somewhat reluctantly, without any major complications or interventions. My attending had to apply sutures again and told me next time I would be the one to do it…
Just by the looks of it, suturing live flesh with fluids and things moving around is very different from the practice I get on the rubbery flesh of my suture kit. Maybe I’ll pick up some meat from the store and practice a bit on that. I am concerned, but I do want to be able to do it.
I also met this nurse who was into anime (she was wearing an Akatsuki scrub cap), we got into this whole conversation about it which was pretty refreshing. She talked about how she’ll sometimes watch with her kids, who are pretty young, so they watch it dubbed which she likes so she doesn’t need to be completely dialed in. Reminded me of Dad, just in the sense that she watches anime with her kids and likes to watch it dubbed, but it sounds like she was the one who got her kids into it.
It was around lunchtime when my attending and I went to the hospital, so I had lunch there even though I made a sandwich. They were serving some hot Mexican food. Then after clinic and before the delivery I met up with a very good friend of mine on her way up north and we got pizza at this place that was recommended to me. They do these Indian-inspired pizzas, so we got a split pie: half chicken tikka masala, half butter chicken. It was pretty good, but I wasn’t blown away. I wanted them to be a bit saucier. My sandwich is in the refrigerator.
Tomorrow, we have a Zoom conference thing with the school, basically a research symposium. It should be interesting, but also my attending is inviting me to join him for a laparoscopically assisted vaginal hysterectomy in the afternoon, so I am hoping I’ll be allowed to leave the symposium early.
I didn’t end up getting called for a delivery last night, even though there were two. I did get a text about the later one, but I didn’t see it in time. I was able to get up at a normal time and go to clinic. The usual mix of ob follow-ups and the occasional gynecological concerns. Otherwise, it was a pretty lowkey day. Got to practice some more suturing and we finished with our last patient pretty early (on schedule). That transitioned to some laziness when I got home. Took a pretty long nap and spent most of the afternoon/ evening in bed.
Maybe it’s compensation or call it coping. I don’t have any call shifts baked into my schedule, so this was my first time really experiencing going to the hospital late. My attending sent me home twice. It’s honestly crazy to me thinking about how much sleep he must have gotten last night and then still had to come into clinic today. I don’t know if I would still be a functional human. Being witness to that I can understand when he can be a bit short with patients or almost seem like he is not listening, and I can tell that some of the patients feel it. I wonder patients they could see first-hand what some docs go through, would have patience or compassion (that goes for all professions, and I guess for all people [ooo deep])? Not that they express any of their thoughts outwardly if they have them. At the same time, patients are also going through their own shit (part of the reason they may be coming to the doctor) and the responsibility to attend to physicians’ feelings and mental health should not in any way fall on patients.
There’s got to be a better system where we don’t have to compromise patient care and physician wellbeing for the sake of “productivity” and financial efficiency.
It’s been an eventful day, and it’s still not over. My attending is on call and I’m writing this at the hospital as I wait for a potential delivery tonight. We already had two deliveries earlier today. There was supposed to be a procedure, but it got canceled.
Other than that, the beginning of the day was normal clinic, until we got called to a delivery. Unfortunately, some of the appointments had to be rescheduled because of that, but by the end of the day we were able to catch up for the most part. On the way to the hospital we were called by the ED for a consult. We got to the hospital, I got to help catch again and with passing some tools. Afterward ended up going down to see the patient and having to delivery some not so great news.
We finished up in clinic and I went home for some food and a quick break and workout then had to go to the hospital the scheduled procedure which ended up being canceled. But as soon as I got there, we checked in on a recent admit and then had to go back to the ED. After finishing up there we got some food then headed back up to the floor. We got there and went to check on an advanced labor — delivery’s gonna be any time now. We left to check on a new admit it triage. Just starting to get the patient’s history and then we got the call that the delivery was starting. So, we rushed over to get all gowned and gloved, except there was only one gown out. Obviously, I wasn’t the one to take it, so I just stood by ’cause I also didn’t know where to get a gown. I eventually got one, but the baby was already out. Once I was finally donned, I got to do all the cord stuff. Clamp 1, clamp 2, give dad the scissors. Unclamp clamp 2. Collect cord blood. Reclamp clamp 2 higher up. Fundal massage to deliver the placenta. The time finally came when I was asked if I could do sutures. I wasn’t feeling confident, so I deferred. Second delivery of the day done.
There was a lot of time expected until the next delivery and I got some blood on my scrubs, so I went home to change, and came back and have been practicing sutures for the past hour as we wait for the next delivery.
For lunch I had the leftover chicken, which will prob last me a good amount of time and for my snack after getting home I made a sandwich which definitely itched a craving I’ve been having. I ate again back at the hospital. My attending said he would treat me to the best sandwich ever. I was excited. Turned out he meant one of the free fridge sandwiches in the physician lounge. I should have known, though he said it with a sincerity that which was almost unusual, but also maybe it was just wishful thinking. Guess I still gotta work on my read of this guy, the sandwich was still good though, chicken Caesar.
Today was my, “Labor Process w/ Crystal” day. Turns out it was in fact a different Crystal from lactation specialist Crystal; this was RN Crystal. Similarly though, she wasn’t really sure what we were supposed to be doing together. So I just followed her around as she went about her day in the Labor and Delivery unit. One patient had a pretty prolonged labor so I got a chance to see first-hand some the management for that, but also because of that it was a relatively uneventful day. I spent most of it looking at a screen watching fetal heart rates and contractions, desperately search for signs of labor progress.
By the end of the day, I only got to see one delivery, but it was much different from the delivery I participated in last week. This time I was purely an observer. I was also present during much of the pre-“call the ob to deliver the baby” pushing which was pretty crazy. At my first delivery the hairy turnip was already visible. This time I got to see how it got there (and everything involved in that process).
It was an interesting day overall. I learned a lot about all the work that goes into working with expectant mothers between their last prenatal visit and delivery. Definitely helped me grow further in my appreciation for nurses and all that they do (and also reinforced my decision to continue down my current path). I also learned a lot about the culture of this particular Labor and Delivery unit, and I am definitely seeing patterns amongst different professionals. Whether or not any of that can be generalized to other L&D units in other hospitals or to other units within this hospital is yet to be seen. While I didn’t get a chance to work with every patient there, I did get to hear some of the craziness ensuing in other parts of the floor.
I tried to make myself useful when I could, but I didn’t get to do much as far as actually helping or working with patients sadly. Though at one point I was allowed to place a fake IV as part of an in-service that some of the nurses were doing.
For lunch I went to this place called “Quesadilla Gorilla” and got a chicken and bacon quesadilla. It was pretty good, but kinda wished it was bigger, not that it was small, I was just hoping for like a Freebirds sized dilla. It came with a good smokey sour cream though. Went to the grocery after my workout to stock up on a bunch of stuff so I don’t keep eating out on my lunch breaks. Then for dinner I tried my own version this recipe that I saw on YouTube for like a cream sauce chicken dish. Turned out pretty good, but definitely will try to do somethings differently next time, mostly in terms of process.
Tomorrow I am thankfully back in clinic. After spending the day in the hospital, I think I like the clinic environment a lot better.
Mitote is a concept I was introduced to in Miguel Ruiz’s The Four Agreements. It’s been a while since I read the book, but from what I remember he describes it almost like a haze that clouds the mind, or like an unintelligible chattering of voices. I’ve been feeling a lot of that recently. I think it has something to do with this change in scenery. I have less distractions out here, which seems like a good thing if I can take advantage of it. That also means there are fewer mindless activities to default to when I get bored (I haven’t set up my desktop, so no video games), and so I think my mind doesn’t know what to do with itself. I find myself picking up my phone more often, just to glimpse and then put it down, or reopening YouTube or Facebook on my laptop just minutes after I just closed the tabs.
At the same time, I feel like I’m being pulled in a bunch of different directions by all the things that I need to do, or want to do, or feel like I should do. This is held in contrast to my weekdays when I have a very clear direction in my clinical encounters. It feels clear to me that I don’t actually have an issue focusing when I have a clear and specific objective, so in the absence of that I need to take advantage of my environment, some self-awareness, and maybe some creativity to help clear the mitote.
There are certain devices that exist that I feel like have been severely limited by their original design. They were invented at a time when technology dictated what was and wasn’t possible in terms of form and function.
Nowadays, the technology exists to do a lot of really cool stuff that once was impossible, and I can’t help but think that of lot of things we use in our daily lives only exist in their current form because either to change them would require changing all the other devices built around them or they are so universally used that to change them would be a huge disruption to society.
I realize this is all kinda vague and eye-glazing, but take dishwashing machines for example. I have never liked using dishwashing machines and in the times that I have used them, I have never been completely satisfied by the result. There’s gotta be a better way to automatized washing dishes that’s more effective than shooting hot swirly water at them. Or like are quadrilaterals really the best shape for screens and phones?
On the other end of the spectrum, we have all the As Seen on TV stuff, a lot of which is genius in theory, but the world is just not ready/ not set-up for them to be successful.
Ok so I still haven’t been able to see a patient completely on my own here. I was so close. I told my attending the plan; on the next obi (obstetrics – initial visit) I would get the patient’s history and stuff and record it exactly in the way that he does in the electronic note, but on paper so we can easily transfer it. Turns out the obi didn’t want a medical student. Ok no biggie, we’ll switch; instead I’ll just get a brief history on the other new patient who was checked it. Wait, she’s Spanish speaking only. So it was a lot of that in the morning and we kinda just gave up. It was unfortunate because everything that could’ve stood in my way, as far as seeing patients by myself, did. We’ll try again next week.
This weekend my attending is on call, so I told him if he gets a call, if he could let me know so I can try to be there for the delivery. He made some jokes about me saying that I would try to be there, but hopefully he will actually let me know.
I also did my first real bimanual today. I feel like this is a specialty where it’s especially sensitive when it comes to being ok with medical student doing certain parts of the exam. Like, they totally don’t have to say its ok, and yet in most cases they are ok with it (I hope they don’t feel pressured at all). So shoutout to all the patients who have contributed to my learning experience out here.
At lunch time today I got a chance to talk a bit more with the MAs at the clinic. I was just having leftovers from last night. I asked them for recommendations for food, nightlife etc. They have me mostly food recs, which is the more important one and so I have a running list of places to try for food out here. I also got to hear some of the gossip around my attending and also about some of the other students who have come through. It sounded like they liked me and thought I was doing a good job relative to others which felt good (but also it doesn’t quite feel like I’m ahead of any curve whatsoever). Hopefully, they weren’t just trying to be nice.
For dinner my roommate and I went to this Mexican restaurant downtown that was pretty good. It was one of those kinds of places that when the food comes out you feel like you’re getting your money’s worth. We then went out to a couple different bars. The last one we ended at had major locals’ vibes, and by the time we left it seemed like the Visalia nightlife we just starting. An adventure for another time.
I probably won’t write again this weekend, but tomorrow I’m supposed to meet up with some other students who just moved out here earlier this week. Looking forward to it.
nANIMOv 