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It’s Over, But Not Really

It is now just over a week since I marched at my Commencement ceremony and received my diploma. Yes, the actual diploma was inside the folder — which is very exciting since all my previous diplomas (college and high school) had to be mailed to me once the financial office had decided that I no longer owed the school any money.

I suppose that this is officially my first post as an MD. I am now a graduate. I now can tack on the suffix M.D. to my name. I remember just one day after graduation I sat staring at my diploma. As I stared at it, I almost could not believe it was in front of me. I looked at the piece of paper — a sheet of paper that has been the most expensive (physically, mentally, spiritually, and emotionally) paper I have ever earned.
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During the days prior to graduation, I remember feeling excited. At the same time, I also felt nervous. Nervous about being done. Nervous about new responsibilities. Nervous about wearing the long white coat I have wanted ever since I looked into the mirror and saw how ridiculous my short white coat looked. I am now waiting for my long coat. Literally. I sent an email to the Graduate Medical Education (GME) office a few weeks ago with my size. I hope I sent in the right size. Again, I am excited. But again, I am nervous about the long white coat and all the responsibility it represents.

I have a few more weeks before residency starts and I step onto the wards as a new intern. During this time I will have to complete some online modules and get certified for Advanced Cardiac Life Support (ACLS). I will also complete my move into a new place. It is a few weeks that I know will go by very quickly. Actually, I feel like the next few years will go quickly, but I don’t really want to think about that at this point.

And so, my medical school career is over. One chapter is completed. But I know that I am far from the end. Medical training continues at the next stage — residency. I know, too, that it will continue long after I leave residency. Medicine, as they have taught me throughout medical school, is about lifelong learning. In the grand scheme of things, I am still at the beginning. I have “leveled up,” but I’m still at a very low level.

I have a long way to go. I know the road ahead will be hard. But it’ll be full of adventure, I’m sure.

I will continue to blog here. For those of you who have been following my journey thus far, I hope you stick around.

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Film & Medicine

Aside from my pathophysiology paper that was due last Friday (which I need to start finish sometime today), I am done with that two week elective.

Tomorrow I start another two week elective. It’s called “Film & Medicine.”

I’ve gotten some wide eyes when I tell people that I’m going to be spending the next two weeks doing an elective called “Film & Medicine.”

From the course syllabus:

Because film encapsulates narrative efficiently, this seminar screens and discusses feature films which focus on stories about medical care. Films are chosen that explore the humanity of both physician and patient as prominent components of quality health care.

There looks to be quite a few interesting films scheduled to be viewed this year. In addition to the films, we have to write a 2-3 page paper and read the John Irving book The Cider House Rules.

Here are the list of movies:

I’m pretty excited about this class. It should be fun.

Oh, I am going to miss fourth year when it ends.

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Death Is Hard

In the past I have found it easy to say that it is harder to see a sick, hospitalized child than a sick, hosptitalized elderly patient. It is easy to reason that the senior citizen has lived a full life while the child has his future ahead of him. But I think this position ignores the viewpoint of the patient’s family. Sure, sometimes a family is prepared for the death of a dying grandfather who has lived a long life and is going out on good terms. But few are ever prepared for a tragic death that comes on suddenly — no matter what age it happens.

Recently I saw a patient who I shall refer to as Mrs. B. We were not the primary team. I saw her as a consult after she had been in the hospital for a rather extended period of time. At the time the consult came in the team was pressed for time so we split up the duties. I would go and talk to the patient while my colleague would put together a consul note summarizing the hospital course and patient’s past medical history using the patient record as a source.

Without reading anything about the patient I went off to find Mrs. B. All I knew about her was that she had been hospitalized for quite some time and that she was fighting an infection that had spread to the blood. As I walked up to her bed she lie silently with her eyes open. I asked her how she was doing but couldn’t make out what she was saying. I tried to ask her in Spanish but she only responded with a more excited mumbling sound.

I realized that I wouldn’t be able to take a history from her. That sort of thing is difficult in non-communcating patients. So I proceeded to perform a quick physical exam. I noticed scleral icterus (jaundiced, yellow eyes) and a few skin wounds. But nothing else really jumped out at me. I left, but not before looking over her chart and collecting her vital signs for the last 24 hours.

When we began rounding our attending began writing out Mrs. B’s information across the large white board that hung in the workroom. Everything we had been able to find from the review of the patient record went on the board. We dissected and discussed the details and the big picture. And, after almost two hours, our attending decided it was time to go and see the patient.

We paused at Mrs. B’s door to pull out some gowns. A nurse ran up to us and whispered, “She just died. The family is inside.” And, while looking at the nearest clock she added, “She died about an hour ago.”

I was shocked. I didn’t know what to think. I had just seen her and touched her just over two hours ago. And now she was gone. At the time I saw her, I had no idea how sick she was. And my physical exam didn’t tell me she was so close to death. During our discussion, though, our attending noted how bad her labs looked and that she would probably benefit from palliative care.

I don’t know how the family took her death. I didn’t go inside the room. I didn’t come back later. To me her death was sudden. I was not expected it so soon. But death, it seems, waits for no one. When it’s time, it’s time.

It is hard to care for sick children in the hospital. But I think it can also be hard to care for sick adults who face tragic endings as well.

Death is hard. Period.

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Tears

I used to say that I am immune to tears. I grew up with a baby sister. I saw many tears. And admittedly, some were caused by me.

But I have realized that I am not as immune to them as I thought.

I am only immune to some of them. The kind that are manipulative. You know the kind. The kind that flows like a never-ending river when a child is not getting his or her way. The ones that go along with the sad, puppy-dog eyes that beg for you to give in. These kinds of tears I can handle. I can laugh at them because I will not be manipulated like that. I refuse.

But then there are the other kinds of tears. The tears that flow due to deep, heart-breaking pain. I realized this for the first time when I stood in a patient’s room. The patient lay in the bed, sedated by medications. The attending stood in front of me, trying to explain the circumstances to the family members.

I remember seeing the tears. I also remember hearing the guttural, almost-primal screams of agony and despair. The words they cried out weren’t even in English. But pain needs to translating. Theirs was a pain borne from unexpected outcome. The patient had been discharged home just days before. That night I had worked on the admission and, with the help a translator, been able to communicate with the patient. But over the course of 10 hours the patient had deteriorated and pain and anguish was what was left in the room.

I physically removed myself from the room. I had seen sad situations many times before but this one got to me. I could feel my eyes start to water. My throat got tight. The air was thick and heavy. I needed to take a few breaths.

I used to say that I am immune to tears. I cannot anymore.

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How Do You Like Loma Linda?

How do you like Loma Linda?

Over the course of this interview season, this is a question that I have been asked numerous times. The person asking me really doesn’t care whether or not I like the city of Loma Linda. The implied question is whether or not I like Loma Linda University School of Medicine. The question is one that has been asked by fellow interviewees. It’s not unusual. While waiting in a room full of interviewees, conversation usually starts out with asking each other what school one is from. This question is usually followed by a “how do you like it there?” question. Invariably, the answer is positive — or at least neutral.

I don’t think I’ve ever heard an applicant say they didn’t like the school they came from. And for some reason, I somehow doubt that anyone would admit to disliking their soon-to-be alma mater — at least not while on the interview trail.

So how do I like Loma Linda? I like it very much. I think medical schools are more similar than different. We learn the same material. We take the same national exams. Sure, each institution offers their twist on how the material is presented, but the material is the same.

One thing that is different here is Loma Linda’s emphasis on Whole-Person Care. The curriculum is designed to not only emphasize the physical pathophysiology, but to also highlight aspects of spiritual care as well. I feel like I have been encouraged to go beyond the diagnosis — to treat the patient and not just the disease.

I have accepted that I attend a medical school whose name does not carry the weight of an ivy league establishment. I have become accustomed to puzzled looks when I say that I go to Loma Linda University. Many people outside the area have never heard of this place. Saying I attend a medical school in Southern California usually gets guesses of UCLA or USC. But once in a while I do come across people who have heard about Loma Linda.

On a recent interview, a program director in another state noted my educational pedigree. Glendale Adventist Academy for high school. Walla Walla College (now Walla Walla University) for my bachelor’s degree. Loma Linda University for medical school. “You must be a Seventh-day Adventist,” he said to me. He continued, “we like students from Loma Linda. Do you realize that your ethics curriculum is more extensive than most other schools?”

On another interview a resident asked me what school I came from. When he heard I was from Loma Linda he said that it was plus for me since the program liked Loma Linda students — they’re usually a really nice group of people.

It was nice to go outside of the this insulated, geographical area where everyone knows of Loma Linda University and hear other opinions of my home institution from people who have no incentive to say anything nice about it. Or maybe it was just a little bit of validation that I appreciated hearing.

So how do I like Loma Linda? Evidently, I like it very much.

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Since I started medical school, I get the occasional item in the mail that looks like this — a letter addressing me as Dr. W. The front of the envelop usually says Jeff W. M.D. above my address.

It always amused me. I suppose you could say it tickled me.

I felt the same way when I saw this today.

And then I realized that after labor day weekend next year, I will have earned those two initials.

I know I’ve made a similar statement a couple of times in recent months. But it’s only because the whole idea is still surreal to me. It hasn’t sunken in yet.

On Thursday I will be taking USMLE Step 2 CS, one of the many exams we need to take in order to get a medical license and DEA number (we need to pass USMLE Step 1, Step 2 CK, Step2 CS, and Step 3).

Sometimes I feel like I’m barreling towards the finish line. At other times I feel like I’m plodding along at a snail’s pace. Regardless of my perception, I’m moving steadily towards May 27 — scared and excited all at once.

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7 Weeks

This week I am beginning my three weeks of Christmas vacation. Following those three weeks I have scheduled 4 weeks of vacation time. All in all, that’s 7 straight weeks off.

Upon hearing about my schedule, many residents have sighed and said, “Oh, the life of a 4th year. Enjoy it while it lasts.”

It won’t be all fun and games, though. This first week I’ll be studying for Step 2 CS and taking the exam on Thursday. The following couple weeks I’ll be finishing up my interviews. But then I will have a few weeks off at the end. I’m still not sure what I’ll be doing. There has been some talk about the possibility of going to Korea. My sister is leaving for Korea in about 1 week. She’ll be teaching English there for 4 months. She would like me to come visit. Well, I’d like to go visit too.

But I’ve also considered other travel alternatives. The others are all cheaper than a trans-Pacific flight. One option would be a road trip. I considered just driving east and just going for a week without any planned agenda. I considered flying out to the east coast and just wandering around for a while. I also considered trying to talk my parents into letting me use a week of their time share somewhere — perhaps I’ll go to Hawaii again.

Obviously my mind is all over the place.

We’ll see, though.

Whatever I end up doing, you better believe I’ll be posting about it!