I transferred out of transport and into an oncology ward as a nursing assistant in October. I really wanted to have more meaningful patient interaction experiences. And it's been nice to actually interact with people for longer than ten minutes, and to actually have a chance to watch their case progress through its stages.

Cancer is a disease of a healthy population. That seems counterintuitive, but its true. Without considering childhood cancers caused by inherited genetic instability, cancer can only invade a population that is healthy enough to live long enough to acquire it. Millions of base pairs get replicated each day, some incorrectly, and these genetic mutations sometimes go unfixed. Unfixed and persistent genetic mutations eventually lead to other genetic mutations, which eventually mutate something required to keep cell growth in check, and boom, unregulated cell growth. Cancer.

I work in a stem cell transplant unit. Some of the very sickest people come to my ward. Those who are about to receive a transplant, those who have just received one, and those dealing with the complications from one. Despite our best efforts, survival rates for cancer as a disease class have not significantly improved since the "War on Cancer" was declared in the 1960's. Sure, there are some cancers that have excellent survival rates and that, for all intents and purposes, we really can just "fix," but these are the exception rather than the norm.

I hate to be all depressing, and I'm sorry I'm not citing my work, but the main point of this post is not to discuss cancer, but to discuss clinical detachment. That magical protective barrier that clinicians build around themselves in order to be able to do a good job for their patients without becoming emotionally involved.

I arrived on the ward after one of the ward favorites had just passed away. I don't think I ever even met her, except perhaps in passing. The next person who died was someone who arrived back on the ward after a brief stay in a nursing home. I was witness to her "code" and saw the flurry of activity that accompanies calling a code. I think I passed out barrier gowns and tried to stay out of the way. Se didn't pass that day, but sometime later, surrounded by her family. I did not cry or get upset.

There have been several people who have passed while I've been here, no one who was directly under my care at the time, but people that I helped care for, people whose names I knew. I felt detached from them and their situations. I certainly felt that their situation was unfortunate, but it wasn't my situation, and cancer, after all, is kind of a bitch.

But that emotional fortress I thought I was so cleverly hidden behind has cracks. I am not a stone, and I do sometimes become emotionally involved. The patient whose situation had me crying on the drive home last night is thankfully still with us today, although the case is complicated. There's a really wonderful spouse, there's an army of grandchildren, there's a whole life that occurred before this moment, before the word cancer changed a lot of things.

It wasn't the tears of the patient. It wasn't the pressure ulcers. It wasn't the sight of the grandkids even, really. I think it was the tears of the spouse. The patient is in pain. The patient is not perfectly lucid. The patient is asking the spouse to let them go, let them die. The spouse starts to cry. The aide at the bedside, usually so reserved, usually so much better at doing what must be necessary without emotion, is crying as well.

But vitals must be taken. Blood sugars recorded. Daily intakes and outputs collected. The ward must be rounded on. I cannot dally too long, but regardless of where else I went that night, I was still in that room, holding the patient's hand, getting the spouse blankets and pillows as the spouse prepared to stay the night.

I think it's harder when you see that someone loves them. We all assume that they have loved ones, but when you see it - day in and day out - the strain of caring for, and I mean really caring for, a sick loved one...the heavy bags under their eyes, the hand holding even while the other one is asleep...that's my weakness. I can too easily imagine myself in their place, can too readily imagine what they must feel.

Death is the final part of life, the inevitable end to this biological moment. For my patients, it is the end of suffering, the end of pain, the end of chemo. But for their loved ones it continues on. Life, suffering, memories. My empathy gets the best of me when it is their pain that I witness, and not the patient's. There is no cure for that, and I cannot help abate it.

Here we go

Well, there went summer. I did not cure cancer. Heck, I'm not even sure I figured out what I intended to figure out, although I did learn a lot. If research taught me anything, it taught me that data contains both interesting positives and pertinent negatives. It also contains "huh, I have no idea what that means." moments.

But that's neither here nor there. Here we're standing at the beginning of my actual senior year. At the end of this school year, I will finally graduate with my undergraduate degree(s). I decided that enough was enough and that I was ready to move on. It's kind of terrifyingly awesome because the next steps are actually rather cool.

I'm taking the MCAT in May. I signed up for a Kaplan course (and managed to negotiate a discount with them for my entire college...woot). I'm taking Physics 1 and Organic 2 with lab this semester. I'm also working in the lab 10 hours a week, participating in student government, shadowing doctors, and trying to find time to do the things I enjoy. I rediscovered some of my hobbies over the summer and decided that they need to be part of my life, regardless of what else is going on.

I also interviewed for and became the "final candidate" for a higher position at the hospital. It has far more patient contact (and actually counts towards patient contact, go figure!) and will give me the opportunity to confront death, dying, and survival in a much more immediate sense.

I am happy. I always wondered what you could do with your life if you didn't spend all your waking hours reading crap on the internet at a job you didn't like. Turns out you can do whatever you want with your life if you get all that time back.

Little chances

So, I'm a huge television junkie, which I think we've already established. This time of year, things are running down to their season/series end, and that means lots of reflective episodes, lots of goodbyes, lots of the ole "take a chance and never look back" message.

I've been thinking about that whole message lately, and how it translates into my life and choices. There aren't any big plane rides that I have to take, any tables of roulette that I need to bet on... in essence, there aren't any lines of demarcation between making the "Big! Giant! Choice!" and the aftermath. For me, it's all a bunch of little chances that might translate into big changes.

The decision to go to med school was not met with a sudden change in my life, although it was toasted with much fanfare and congratulations. It was a big decision, admittedly, but the changes it mitigated were small ones. My class schedule filled up with science and math, my timeline to graduation lengthened, and I added a major to my ever-growing list of credentials.

However, looking at my life this morning, while walking to the lab, I was struck by how different it was from my life two years ago. Two years ago, I drove to a job I couldn't stand, to do work that was uninspiring, for people who didn't appreciate it. My days were an endless recreation of the one before, and while graduation was on the horizon, the changes it would bring would be minuscule to my day-to-day.

I had no idea what was going to happen, or if it did, it would be satisfying and worth all the work I had to go through to bring it into reality. Majoring in public service was something I did because it was easy - the classes were offered at night and on weekends, the subjects were not too challenging, and the work I would eventually be "qualified" to do wasn't that much different from the work I was already doing.

I had a happy life - don't get me wrong - but I didn't realize it at the time. I often felt that something was missing, that I had taken a wrong turn somewhere, and I felt a profound sense of loss for a life unlike the one I was living.

Fast forward to today. I'm about half-way through the pre-requisites for applying to medical school, I'm working on a summer research project funded by the National Institutes of Health, I'm a certified Emergency Medical Technician, and I'm working towards a more patient-centered position at the hospital in which I work.

These changes did not come about overnight or even relatively quickly. They were the conscious effort of many small decisions over a long period of time. I read somewhere that our "...futures are dependent upon today's behaviors and actions." I'm finding that statement to be far more relevant than "take a chance and never look back."

In addition to lengthening the timeline of change, it also lowers the stakes of each choice quite a bit. There are many choices that once made cannot be unmade and that forever change your destiny - but these choices are often the exception, not the rule. It is far more commonplace for there to be a series of choices that actually bring about the change we wish. This gives us a great deal more leeway with individual choices, and allows us to experiment and see how the individual choices impact our environments.

I think my basic point is that it's certainly fun to watch Rachel Berry get on a train and arrive in New York City, her life forever and instantly changed, but it's not very realistic. Alas, it's hard to celebrate the little changes at the moment when a choice is made, but maybe it's better to realize that a long time ago, in a land far away, I once made a choice... and that no matter how small or insignificant it seemed at the time, it set the stage for a whole host of other choices that would eventually bring me to today - and that today is a beautiful thing.

Looking forward

Well, I did it. I survived Ochem 1, and got out with a B+ for my efforts. Ochem 2 is in the fall, but before that, there's a whole summer of no-classes. This is my first summer off in seven years, and I do plan to enjoy myself quite a bit.

I've started looking at schools, it's actually rather enjoyable. Mr. Crazy has endorsed the plan to sail off into the sunset WITH me, which is actually a change from what I expected. So, between the two of us, we've been doing a lot of broad-strokes of rejection to potential schools - too far! too south! too west virginia!

In all seriousness, there's a lot to consider as I narrow down the list. I started by gathering all the schools in the surrounding states, and then knocked out any school more than 300 miles away from the 'burgh. Last October, I made a declaration that Family Crazy does not drive more than 300 miles, because longer than 6 hours in the car is insufferable.

The next thing I did was pull the rankings from the US News page, and start to rank schools into "safety/good shot/long shot" categories. The Student Doctor Network forums gave me another good list of things to consider - required lectures? Hospitals where clinicals are done? Hours spent in lecture? And other such assorted questions to consider.

I'm down to a list of about 22 different schools, spread all across the eastern seaboard, with a giant excel spreadsheet recording notable details. I figure this summer is a good time to narrow down the list, especially considering that I don't have to obsess over anything academic besides research.

Once I made the decision to go, the future has never been uncertain. For me, this is a certainty. But actually starting to think about where this is going to take place has given the dream a certain quality of realness that eclipses all other things I've done so far.

Well, I think my plasmid is done CIP'ing, so, off to purify some DNA...

Abe says I'm supposed to post...

I demand a lot of myself. I work weekends, I have class five days a week, I volunteer, I do research, I serve on student council, I have a husband and a kid. I recently "amped up" the studying too, devoting at least twice as much time to it as I had been. It actually improved my understanding of the material, and certainly made me feel better about organic chemistry.

Anyways. I started working out three days a week too, hoping it would give me more energy. It really did, I am far less tired when I get home (whenever that is) and my physically demanding job actually seems a bit less demanding. Combine that with the fact that my average work day finds me walking 8 miles and pushing 4,000 pounds (yes, I added it up.)

I've been acting like all the kids I'm competing with, yet I am still 34. I had this theory that as long as I ate right, exercised, worked out, got my rest, took my vitamin, that I wouldn't feel the effects, wouldn't actually feel any of those years...

Wrong.

I started having back spasms this past week, walking out of class with my gazillion-pound backpack on my back. (Dude, I even wear the sternal strap and look like a total dork because I'm trying to distribute the weight appropriately.) I saw two chiropractors and my PCP, took a week's worth of steroids for inflammation, got some awesome muscle relaxers (did I mention I love being a grown-up because they FINALLY give you good drugs?), and ... you know... totally didn't take it easy at all. What? You saw that coming.

Anyways. I don't know what my point is. Maybe my point is that the road to med school is hard and made even harder by the fact that the mind is so much more willing than the body. I've decided this latest turn of events means physical therapy and at least once-monthly massages. I've been taking care of my body chemically, getting my cardio, and feeding my brain...but I haven't actually been taking care of all the other stuff that moves me from place to place.

The years come with wisdom and self confidence, but that comes at a price. You can't go all those miles without a little wear and tear and unfortunately, some of mine is starting to show.

*This post was written on a combination of some really sweet drugs. (That were prescribed for the author.)

It was in the afternoon. I'd been volunteering for about two months at this point and had seen all the "basic" calls - diabetic with low blood sugar, shortness of breath, transfers to hospice, chest pains, etc. It was another shortness of breath call and I remember thinking "Another one? When am I going to get to see something good?"

I'm aware that wanting something interesting to happen makes me morbid and inconsiderate. But in my mind, "something interesting" happens all the time anyways, I just wanted to be there when it did.

It was still sunny when we arrived. He had his shirt open, exposing his chest, and looked "sick". Or apparently looked sick, because I didn't notice, and it was only because the medic noticed and later talked about it that I can relate that. Seventeen years on the job will give you those sorts of instincts... I hope to someday have them too.

He only said he couldn't breathe, and then his spouse took over. He'd had recent surgery. She had been at the store and came home to find him complaining of having trouble breathing, so she called us. He passed out almost instantly, and we moved him to the floor. The medic and the other EMT started assisting his respiration. I took over bagging while they did other things.

The medic was trying to intubate and asked for "cricoid"... the other EMT was confused, maybe he didn't hear her correctly. We talked about that two weeks prior in my human physiology class, so I placed two fingers over where I imagined his thyroid was. Later the medic told me she was impressed that someone who'd never been on an arrest call knew what to do. It made me glad I study.

Another medic showed up to provide "Advanced Life Support Backup" (ALS Backup, so they say.) He started an IV. Fluids were pushed. I felt nothing while this was occurring. I was too busy counting to 8 and squeezing the Bag-Valve-Mask (BVM). He was packed up into a Reeves stretcher, and moved to the actual stretcher waiting outside. Somewhere between the house and the rig, he lost his pulse. The medic started chest compressions while everyone else strapped things down and got ready to move.

At some point during the ride, I took over compressions. I still felt nothing, but couldn't stop counting to eight. Just a continuous 8-8-8-8-8, this time with no punctuations of squeezing a bag. His eyes were open, seeing nothing. Emesis was coming out of his mouth, on the outside of the ventilation tube. I did compressions until I needed a break. The other medic took over.

We arrived at the hospital. It could have taken five minutes or an hour, I was unable to account for the passage of time. The medic directed me up onto the rails of the stretcher to continue compressions while we wheeled him into the ER. Later I was informed this was the "glory spot" and was called "riding the rails."

Report was given at bedside. I removed my gloves and washed my hands. I stood in the room and watched the nurses, doctors, and other professionals take over. I became aware of beads of sweat running down my abdomen, inside my uniform shirt. I was not shaken, did not have the jitters, and was not consciously aware of any adrenaline rush. But I could hear, see, and smell everything. I was focused on the task at hand. I felt no emotion.

They recovered his heartbeat at the hospital. We cleaned the rig. While I cannot guarantee how long his heart continued to beat, it was beating when we left. I do not know if he woke up. I don't know what happened next. I know only that I crossed the line that afternoon, from the group of people who've learned CPR and never used it, and into the group of people that have.

I felt unsettled the next morning. Not unhappy. Just unsettled. I couldn't get a grip on how I felt about the experience until several days later.

I feel good. I feel like I was a taught a skill and then trusted enough to be placed into a situation where I needed to use it. The classroom did not prepare me adequately, but does it ever? I got an "A" in my class, and had the top score for the state test. It was not a lack of preparation, but simply that nothing can prepare you for that experience.

I hope to be better prepared next time. I hope to provide better assistance. I need to learn where the leads go for the monitor, and how to set up the capnography apparatus. I don't want to let this whole thing go without examining it and trying to figure out what I need to learn.

What I learned most of all is that I can respond appropriately in an emergency and that my adrenaline rush comes in the form of increased focus and a methodical approach. The world for me slows down, and I with it. I learned... that I chose well for my future profession. That I want to be here, dealing with these issues, and that when I get there, I'll be completely unprepared but totally willing to learn.

(details have been changed in order to mask identity)

My primers worked! My PCR scheme worked! My gel worked! It was an awesome day in the land of research. Last semester I was doing a genotypic identification project on the 800+ strains of yeast that the lab uses... this semester I'm doing a protein-protein interaction study with yeast-2 hybrids. It's funny how things accelerate quickly once you know some basics, no?

Anyways, the lab is awesome. I came in just as things were getting started and rounded out the lab "staff" to 3.5 (there was a guy who only did summers, the PI, and the lab tech when I first started). Now we're up to 6.5 and have a bona fide "media preparer" working the lab. It's an exciting place to be, and it's fun work. The PI is on the younger side and is wonderful to work with, always explaining things, making jokes, and making sure we understand.

I didn't know research would be fun. I started out looking for research because "you're supposed to do research" and was quite honestly intimidated by it. Now that I'm actually doing it with some success, I can't believe I didn't start sooner. There are lots of people "volunteering" in the research lab who not only get to park for free and earn a free meal when they put in more than four hours, but they get to learn all kinds of interesting research skills. How are more people not doing this?

Oh that's right... not everyone is nearly as interested in this stuff as I am. Anyways. This Friday there's a research symposium at my university - an undergraduate event put on by undergraduate researchers FOR undergraduate research hopefuls. It's supposed to provide an opportunity for people to ask questions, talk about their research, and help other people get into the lab. In that vein, I guess I'm here talking about it in order to encourage other people who may not have figured out "the research thing" to jump in and give it a shot.

So, who else is doing research, and what are you doing?

(PS - Thank you Dr Fizzy for the shout out! And WELCOME! to my new followers who came here via her blog.)

Humanism in Medicine (Probably just part one)

I started my "post-decision" volunteering by volunteering in an ER. It was a small, local hospital in the suburbs and for the most part, I felt like I was in the way. I was only there for about two months before I had to take a leave of absence for classes, but the experience was such that I did not elect to go back.

Instead, I decided to become a certified EMT and volunteer with a local ambulance service. This experience has been much more productive, I don't feel like I'm in the way, and I'm learning a ton of stuff. In fact, I generally can't wait until EMS-day and wish I could find a way to fit it in more than once a week.

Much as I really enjoy my volunteer experience, I had a call the other day that really drove home a significant point for me. I've literally spent years watching medical dramas, reading med-student books, blogs, etc, and I've always thought the same thing... "Gee, some of them really dehumanize their patients and catalogue them as nothing more than procedures... that's totally not going to happen to me!"

Well. It did. It's hard not to get caught up in the moment. It's extremely difficult not to get excited that I got to perform such and such a procedure for the first time. And the capstone on all of that is that it's even harder to remember that this is someone's father, mother, grandmother, sister, loved one... that is going through a very scary medical crisis.

I know that I cannot allow every single patient experience to affect me so profoundly or access my emotional bank... but I'm going to have to find a way to keep the human aspect within sight. I also understand that learning procedures today will help me become a better clinician, will help me save people down the line, and will ultimately be good for me and everyone I come in contact with... but that doesn't mean that I have to reduce people down to an intubation, or a successful blood pressure check.

This experience is uniquely mine, but it is not mine uniquely. I imagine the vast majority of clinicians ahead of me (and those who will come after) have struggled with this issue and found a way to muddle through. I'm going to have to do the same thing.

I am nearly ashamed to admit that I didn't think this would be an issue for me. I honestly thought that because I was thoughtfully considering the human aspect of medicine that I wouldn't have to have this little heart-to-heart with myself. Turns out this was just one more thing I was going to have to experience before I'd truly know how I'd react.

Shadowing

So, this may come as a bit of a surprise to some people, but I can be a bit shy from time to time. Not, say, in everyday life or in normal circumstances that plague regular people, no. But in unfamiliar situations, well then yes.

Case in point: shadowing. I need/want to shadow some doctors. I'm not even picky, and I kind of want to shadow all different kinds. I work in a hospital that is chock full of doctors. This seems like it would be easy. Walk up to doctor, say 'hey, can I shadow you?', he says yes, boom, done.

But it isn't that easy for me. I mean, is that what you actually do? Is there a form that needs filled out? How do I get him to see me as a real person and not a stretcher-monkey? What if he says no? That's generally my biggest concern. If he says no then I will be embarassed every time I see him and will feel silly having asked.

Do doctors like having med school hopefulls following them around? Or is it annoying? I just don't know. So here we are. I'm swimming around in a sea full of the resource I need, but scared to take a sip.

Today I'm meeting with my med student mentor, so hopefully she has some insight into the process and maybe, just maybe, a little bit of what I like to call "the hookup". I mean, it couldn't hurt, right?

Everest is a big mountain...

So, while I was project managing, one of my favorite stories was how when you climb everest, you have to keep going down, then going back up, then going back down again, in order to acclimate yourself to the lower atmospheric pressure (and thus lower O2 pressure). It was basically a story about how getting there sometimes requires going in the opposite direction.

So anyways...here we are in the "new" version of my life and I find the same to be true. Over the summer I learned that we shouldn't over-schedule ourselves if we want to be successful. Now I'm learning that if you didn't get everything you needed in "First Semester of Subject" you won't actually understand anything in "Second Semester of Subject".

This seems like a no-brainer, right? The only problem being that my first degree, while progressive, did not have a linear progression to it. If I didn't like Practices in Human Resources, I only had to suffer for fifteen weeks, memorize enough to pass, and then it was over. With science, if you don't understand acid/base chemistry, there is no escape. It will keep coming up again and again over and over until you just hunker down and actually learn the differences between pKa, K, and pH.

So. What does all this mean? It means getting a "C" in Organic Chemistry I is not enough to prosper in Organic Chemistry II. So here I am again, in OChem I...

...and yes, I feel a bit "fail-y". But I also learned that true failure isn't retracing your steps, but in ceasing the journey altogether. And quite frankly, I'm not giving up. I'm trying again, this time with more focus.

Besides, this gives me a great way to segue into examples of my perseverance and show proof that I don't give up. I'm shooting for an A+ because I think it makes the point all the more poignant.

(And looks good. Let's not ignore the fact that I'm a weaselly pre-med student...)

(By the way, if you are also pre-med, or post-med, or interested in the life of the med student, or medicine, or hey, just happen to like funny things, cruise on over to this blog.

and check out the funny cartoons. And then, if you really like 'em, you can get them in book form!)

Yay Doctor Fizzy! :)