nANIMOv

The days really feel like they just go by so fast. Part of it could be that the days are relatively short/ flexible compared to other jobs I’ve had, but only by maybe 2 or 3 hours on the shortest days. The days I spent in the hospital shadowing on the other hand at times felt much longer. And then even on the days where I spent hours after clinic in the hospital it never felt like I was doing busy work or tedious work.

Yet when I come home there’s still so much to do, a lot of which feels like tedium. Whether it be studying or doing research or whatever. These things are important for me to be able to actually be able to be a doctor at some point, but it’s all just so unrewarding in the moment.

Today I got to see a lot of patients who I’ve seen in the past sometime from the first week to last week. It’s nice to be there for the follow-up and a little heart-warming when they say they remember me, though it’s probably not hard to forget the awkward med student from just the other week, or they are just saying so.

As I go a long in my medical career, I hope I don’t develop the cynicism that I often see in medicine. It’s easy for healthcare providers to recognize patterns among their patients and which creates certain expectations as far as outcomes, patient adherence, patient perspectives, and attitudes. It’s natural. It’s what we do as humans. We recognize patterns and think and act accordingly.

I’m speaking very generally, but I’m just saying, when it comes to helping patients reach their health and life goals, I can approach each individual situation with a genuine optimism for success.

I’m strangely starting to feel a bit of sadness with the realization that this rotation is getting close to its conclusion. I have this week and then one more. I’m going to have to say goodbye to the people I’ve met here and likely not see them again. It’s weird how life it like that sometimes. People who play such huge roles in isolated point of our life all of a sudden disappear. I realize it’s perhaps weird that I am getting sentimental over this, but that’s just the way I am I guess.

Today I finally asserted myself to see some patients on my own. It went pretty well I thought. My attending would go off to see a one patient and I would see another, and then he would come in at some point. When he came in, he basically would just do the whole encounter over again and it was reassuring in that it meant what I talked about with the patient was pretty comprehensive. There would be things I would miss here and there, but all things to keep in mind for next time. It did seem like the EMR problems persisted and we ended up getting a bit behind, so I held off a bit as not to be a further source of anxiety with the record keeping complications. We’ll shoot for some more tomorrow.

Also getting more comfortable with the flow and process of Nexplanon insertions and removals. I feel confident that I could do either on my own, except I would just be very nervous with the patient there or being watched while doing it.

For food still making my way through leftovers, though now I’m down to all home-cooked stuff. We’ll see if it makes it to the end of the week.

Yesterday I sent a reminder to my attending that I was scheduled to be at the hospital all day and so would not be at in clinic. He told me that he would be performing a Cesarean section the next morning (today) if I could make it. It was schedule for an hour before my “shift” at the hospital. I’ve never been to a see section before, so I had no idea how long it would take. The doctor said I should make it in time for my shift, but I wanted to go early to check-in the nurse I was going to be shadowing to see if she would be ok with me coming in a little late if the surgery went long. Which meant I would have to get up a little earlier with no guarantee that she would say yes and no idea if she would even be there at the time I was planning on going.

Long story short I got her approval and got to go the surgery. It was more bizarre than anything I’ve experienced during this rotation so far. After I was scrubbed in, with less snafus than the first time, I realized we were slicing open this lady’s belly while she was fully awake. She couldn’t feel a thing of course and I couldn’t see her face during the surgery, but occasionally there would be evidence of her the position of her upper body or moving her arms that made the situation a bit uncanny.

It was cool to watch as he cut through all the different layers of the belly and being able to follow along as he did so, identifying at what point we reached the uterus and then the amniotic sac.

Once the baby was out, which as an amazing thing in a totally different way from vaginal delivery, the cord was cut and baby was given to mom and dad and we started the process of closing her up. This was were when the consciousness-open belly juxtaposition was most apparent because mom was talking and moving and laughing and there we were on the other side of a cloth barrier using a needle and a bunch of clamps to sew her back together.

This was a procedure my attending seemed very comfortable with (perhaps obviously) based on the speed with which he was throwing sutures and tying knots. It’s always inspiring to watch someone engage in a skill that they have spent a long-time mastering.

I got to be involved in a few small ways. I got to hold some of the tools in place and I got to use the cautery tool to stop some bleeding vessels. Thankfully I wasn’t asked to do any suturing, still not comfortable doing it myself on the live person, but after watching once I think I would be ok to do at least a few bites worth if asked.

The rest of the day was spent with the nurse taking care of post-partum mothers. Similar to all my other days in the hospital, it was informative and interesting to see this side of patient care, and again it gave me a stronger appreciation for what goes on in the physicians’ absence. Looking forward to being back in the clinic again though.

For lunch I ran back home to eat some leftovers from the weekend. My family came to visit and so I got to check out of few more food spots that have been on my list. Dinner, more leftovers. I have enough food right now to probably last me until the end of the week without needing to buy or cook food.

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.