Oxy-CHLA Shadowing Day 8: Surgery Operating Room

Today concludes my shadowing program at Children’s Hospital Los Angeles! I got to end my two-week adventure with a trip to the operating room! Despite having volunteered in two other hospitals, I’ve never had the chance to actually visit the OR or witness any surgeries, so today was super exciting!

What I learned about the unit:

I didn’t realize how short some surgeries are! I literally saw two surgeries that took a total of 30 seconds to complete (lingual frenulectomies). Honestly, the pre-operative procedures took way longer than most of the surgeries I saw. Apparently, today was a pretty slow day, so I didn’t see anything amazing or rare. I got to see two frenulectomies, an emergency exploratory laparotomy, an umbilical hernia repair, a rectal examination with excision of granuloma, and a bone marrow aspirate and breast mass biopsy. All of them took no more than 45 minutes. It was very cool to see how relaxed the unit was. Everything ran every smoothly and almost everyone I saw was really calm. It was a really wonderful concerted process.

What I learned about the job:

You have to be super calm for this job in order to keep things running smoothly, but there’s definitely room for a lot of socializing and joking around. A lot of the surgeons were having conversations about their lives while performing on a patient. It was very cool. I also gained a huge appreciation for the mechanical work that surgery is. You cut (or use a bovie… which is sort of like burning?), find what’s wrong, fix it, and then sew sutures to close (or use a silo bag). You have to be very explorative and be able to distinguish healthy from unhealthy tissue, and then you get to be creative on how to fix it. For example, will you close the skin vertically or horizontally? The answer is usually how the skin best comes together. You also have to flexible because when you get emergency patients, where the procedure will be exploratory, you never know what you’re going to find when you open up the patient. Additionally, if you’re doing a biopsy, you may have to wait to hear back from pathology before closing completely. Surgery not only requires being focused, but also being relaxed and flexible–the latter two I never really put thought into before.

What I learned about myself:

I like the idea of surgery because I like working with my hands. For those who don’t know, I went to a technical arts high school where I took classes in woodworking, metal fabrications, and electronics. I also like to sew at home. I have a very technical background in terms of how I like to do things. I like to build, and if things fall apart, I come up with creative ways to fix them. I think that’s what I really appreciate about surgery–it’s mechanically altering, but improving people. It’s wonderful to think about the fact you can just cut out dead parts of the bowel, and sew the healthy parts together and have a full recovery. Or when you take out a tumor and ultimately prevent the recurrence of cancer. I think I would like doing surgery because I love working with my hands. I think the lack of patient interaction I would get would make me sad though (that’s why I like emergency; you get to do procedures while also interacting with patients really often). I’m excited to go through a surgery rotation in the future because I can’t wait to be the person with the bovie or the scalpel.

Oxy-CHLA Shadowing Day 7: Rehabilitation (Inpatient) and Medical Genetics p. 2

Today, I got to round in the rehabilitation unit and also visit medical genetics again. Again, I will split my reflections into two parts.

Rehabilitation (outpatient)

What I learned bout the unit:

I didn’t know that the rehab unit encompassed more than physical therapy. When we walked into a team conference, there were at least 20 people present, from the attending MD, to physical therapists, occupational therapists, speech therapists, social workers, spiritual coordinators, dieticians, psychiatrists etc. The attending explained to us that Rehabilitation is one of the few medical sub-specialties that is very interdisciplinary and requires a very large team. Rehab aims to treat the patient holistically, which is why often times school coordinators get involved as well as spiritual leaders and psychologists. Also family is usually very involved in the process as well. It was just so different from what I imagined! I got to sit in on a speech group therapy session, where the patients did a deductive reasoning worksheet and then played the game Skip-Bo (which I love by the way) and got to see what really happens. I also got to see a little bit of the physical therapy session, which was also amazing because the room is set up like a small jungle gym of sorts. I also sat in on two family meetings, where they talked about the plan of care for the children, as well as went over the progress that had been made. Some patients had ongoing chronic issues while others were in traumatic accidents where there was both physical and brain injury. Although not as active, it was still incredibly engaging and I’m glad I got to see that side of medicine.

What I learned about the job:

The attending told us that today was a particularly busy day and was a sort of less-than-ideal day to be visiting. The attending was truly the head of everything, and the resident took the day off that day. He was one who invited us to the meetings and had us go with the speech therapist. He also made sure that other MDs who were specialized (for example, rhematology) were informed of the care plan because he got paged several times during conferences. Otherwise, I didn’t get to learn too much. I thought Rehab was very cool though, and I feel like I would enjoy being a care partner of sorts in this unit.

What I learned about myself:

I don’t know if I have a fit here because I wasn’t super interested in doing any of the work they do as a job. I feel like it would be awesome to volunteer here or work here temporarily, but for me, it isn’t the career of choice. I will be able to learn some of the things that happen in PT during my biomechanics class, so that’s pretty awesome that my learning material is relevant. I also now know that CHLA has such an amazing comprehensive rehabilitation unit. If my future kids ever needed the best care, I know CHLA is the place to go.

Medical Genetics p. 2

Today I got to visit this unit again, but this time with a different doctor. I learned all about neurofibromatosis type I (NF1). We saw a 1 year-old with cafe au lait spots (also called macules) whose mom ended up consenting to getting genetic testing just in case. Then soon after, we saw middle school-aged twins that were actually diagnosed NF1, which was very interesting because we got to see how the disease progressed. Both of the children were very active in school and didn’t seem to let their disorder negatively affect their lives. Even though we really only go to learn about one genetic disorder, and only saw three patients, it was still a really nice day. It was nice to have a more relaxing day prior to my day in the OR tomorrow!

What I learned about the unit, the job, and myself:

I’m going to skip this because I already wrote about this in part 1. I visited this unit last week!

 

Oxy-CHLA Shadowing Day 6: Infectious Diseases and Surgery Clinic

Gah this post is a day late because I had to move out of my room yesterday and into a new room. Sorry about that! But now here I am. Yesterday, I got to visit two units: Infectious Diseases (ID) and the Surgery Clinic. I’ll go into each unit separately.

Infectious Diseases (ID)

What I learned about the unit:

This isn’t so much a unit as it is a team of individuals who basically go answer questions from team physicians to check in with patients who may or may not have an infectious disease. Infectious diseases often complicate cases, and can be deadly in those with immunocompromised systems. This department is all about looking at the history of patients (fevers? what time? what grade?) and other possible indicators of infectious disease (hives, rashes, etc) and then doing cultures tests and determining which antibiotics to use in order to treat the infectious disease while also taking care of the chief complaint (whether it was a surgery, a chronic disease, or a debilitating disease like cancer).

What I learned about the job:

In this unit, we rounded with a nurse practitioner as well as a physician (I believe she was an attending). We got to go and visit almost every single patient on the list. Many of the patients were awake and could react to us, and many of them were older school-aged children. We mainly followed the NP, who was super happy and seemed to really love her job. She was very open to answering all of our questions, which was great. She even said hi to patients who she didn’t even have updates for, but just because she wanted to see them. Rounding took about 2.5 hours.

What I learned about myself:

I can’t wait to take microbial symbiosis because it seems like the material in that class would be super relevant. I wasn’t super excited about infectious diseases, though I was very curious about the process of choosing the medications. I probably wouldn’t want to go into this field, but it was very fascinating to understand.

Surgery Clinic

What I learned about the unit:

So this is a consult clinic. Basically a lot of patients who may need surgery come in and talk to the surgeon about whether or not they actually do or should, or what alternative options are. No actual surgeries take place here (or maybe super minor ones do, but I didn’t see any). There are also patients who previously had surgery who were just getting a check-up. One minor procedure I did see was the nurse changing the G-tube. There were patients of all ages, from 3 months to 18 years old, with all different kinds of issues: skin lesions (with bone exposed), anterior displaced anus, pectus excavatum, labial fusion, inguinal hernia, pilonidal cyst, ganglion cyst, etc. So many things! We got to see a lot of patients in a very short period of time, and it was a lot of fun.

What I learned about the job:

I didn’t know that as a surgeon how many hours you actually spend in the clinic, but it makes a lot of sense. I also didn’t know that as a pediatric surgeon, you only perform surgery on patients who are completely asleep (at least the attending I followed said that). I received local anesthesia on a surgery I had, but it’s because I went to an adult surgeon. I also learned how to make the job fun, such as providing toys to all the small tiny humans who step into the exam room. The surgeon was absolutely phenomenal in the way she interacted with patients and their families, making them feel super comfortable but also providing many options. To be a surgeon, you aren’t actually in the OR all day like I thought you would be, but I wouldn’t mind being in the surgery clinic either because you just get almost exclusively patient interaction… and it seems less paperwork than the other units. It seemed like a lot of fun and I think I would enjoy being a surgeon. Maybe.

What I learned about myself:

I really liked this job. One of the questions I was forced to answer was “Why do I want to go into medicine [as opposed to other jobs such as nurse practitioner, physician assistant, nurse, etc]?” And it’s really because I love problem-solving and I love continuously learning about new syndromes, disorders, problems… but also really enjoy finding new solutions. This is in addition to how much I love learning about the human body and how happy it makes me, and how long it has been a part of me. I feel like it’s really hard to come up with a reason for why I want to go into medicine that isn’t really what I just said… I feel like other people have that same reasoning (it’s not a “bad” reasoning. It just isn’t “unique”) It’s hard to tell if my answer was good enough for the attending, and I’m worried that it wasn’t. However, this pushes me to think more about my reasons for going into medicine, and I think will really help me in the application process.

Oxy-CHLA Shadowing Day 5: Hospital Medicine

Today was an absolutely wonderful day at the hospital, certainly my favorite day thus far. I not only learned a lot, but had a lot of interaction with the attending, fellow, resident, medical student, and the patients! I didn’t know what Hospital Medicine at first, but it appears to just be the general pediatrics floors, or the non-ICU floors. Also the hospitalists work exclusively inside the hospital (as opposed to outpatient work). It was a really wonderful and interactive experience.

What I learned about the unit:

The general pediatrics floors are great! Most of the patients are on the upswing in terms of their recovery, and many of them are awake and active, unlike the ICU floors. The wings were specialized I think, but it wasn’t made super clear to me. Many of the patients had acute problems, like back pain, while others were therefor cystic fibrosis treatments or chronic lung disease. This unit was a lot of fun to go around, and the entire team (Team 2) was super friendly.

What I learned about the job:

As soon as we walked in, a medical student greeted us and went over her two patients. We got to see her rehearse to the resident, who gave her feedback. Then we got to round on about 8 patients with the attending, fellow, resident, medical student, and clinical care coordinator. We got to go into almost every single room. At first, it was mainly the resident talking about the patient as well doing their physical exam. However near the end of rounds, the attending and fellow invited us to stay with a patient and explained what they look for during a physical exam: fontanelles, listening to lungs, myoclonic movements. Both the fellow and the attending took time to thoroughly explain what they were doing as well as answer any questions we had, no matter how simple it seemed. They even knew our names personally, which made a huge difference in my experience there. It was nice to know that even as a fellow and attending, there was still time to teach–a huge part of me. The attending also took some time to go over some XRays. I would say the best part is that the attending asked us to state what we observed about patients: are they relaxed? how’s their color (pale, flushed, etc)? how’s their muscle tone? when they wake up, does their state change? what do you observe on this XRay? The attending did such a phenomenal job at both explaining and teaching that I didn’t even feel tired despite functioning on 2 hours of sleep.

Some complicated things I learned about being a physician, especially in pediatrics, is that there are times when there will be non-accidental trauma patients. That is another word for child abuse. I learned some things about how to look for suspicious injuries (such as posterior rib fractures, which are much harder to attain than anterior rib fractures, or retinal hemorrhaging). Furthermore, it’s hard to give care on a pediatrics patient when basically all procedures require consent, but obviously pediatrics patients cannot give consent. So in NAT patients, there are legal components to care as well as the medical, and physicians cannot get involved in the legal. Just gotta wait for that to be sorted out.

Another frustrating thing is knowing that a patient needs imaging or a test in order to help accurately diagnose them, but sometimes parents freak out and won’t consent. It can be super frustrating, and I saw the team basically go “what the heck” when they found out a patient went up for an MRI, and at the last second the parent refused consent because they were told the patient was a “high risk” patient due to a condition they had–despite imaging being done on other patients with the same condition all the time. I knew the patient’s case, so even I felt really frustrated because I knew the MRI would likely reveal a lot (or perhaps nothing at all) and aid in the care of the patient.

I feel like today provided a lot of insight on the breadth of responsibilities and duties as a physician to their patients and to their team. I’m really glad I had the preceptor I did!

What I learned about myself:

If I wasn’t super sure about pediatrics before, I can say I definitely like pediatrics now. I really loved being on this floor. How does this compare to adults? I don’t really know yet. But I definitely like the general pediatrics floors more than the ICU floor. I really liked being able to interact with more patients, especially those who were actually awake and could react to me. It’s also nice not seeing patients filled with tubes at every orifice (not that the ICU bothered me, but it was very sad to me). Although I didn’t get to go, the toy playroom was present in every single wing, which I thought was awesome. The floors just seemed super fun compared to the other units I’ve been in. If I had to choose pediatrics, I would definitely choose general pediatrics over ICU (but I haven’t been to the Emergency Department yet! So who knows for sure).

Oxy-CHLA Shadowing Day 4: Lectures

Instead of shadowing physicians in a unit today, we were scheduled to have lectures. CHLA seems to have regular speakers (unclear if weekly or monthly) called “Grand Rounds.” Today we got to hear from Johanna Olsen-Kennedy and her work with transyouth, which was amazing. I feel like I learned a lot about how taking care of transyouth is a very comprehensive and all-encompassing regimen. But the outcomes are largely positive, and lead to thriving trans children and adolescents, which makes me very happy to hear.

After that lecture, we had a Q&A with one chief resident, followed by a Q&A with two 3rd year medical school students from USC. Some of the major takeaways (and I’m just thinking off the top of my head, indicating the ideas that stuck out the most):

  • To be a physician, you can’t just think of it as “just a job.” Some people like to think of it as a vocation, or that medicine is their calling.
  • Cynicism is a sign of burnout.
  • Do you like wearing a white coat? Because if you do, pediatrics is not for you. (I thought this one was funny, but so true).
  •  Med school applications are 99% your work ethic, passion, and commitment. You don’t need clinical work, and you don’t even need to have done your pre-med classes during undergrad. You just need to know it’s what you want, and work really hard at it.
  • Think about how much you want to interact with your patients, and how much you just want to sit around and think.

I know I wrote way more takeaways, but these are what came to mind. So these are the ideas that resonated with me the most. The first one especially resonates with me because after having spent 72.75 hours in the ER in a month (my hours finally got calculated y’all), I have definitely told my friends, “The ER is my calling. I know I love it.” I’ve been in the PICU, CTICU, and in Medical Genetics and none of those things gave me as much excitement and passion as thinking about the ER. So I was super happy to have heard someone describe their job the way I would.

After the Q&A, we had another lecture from the Cystic Fibrosis (CF) team. The team basically went over the pathophysiology and biochemistry of CF, as well as how it is treated: respiratory, diet and nutrition, and psychosocial. I thought it was so cool to learn about CF in-depth. I never knew that it affected more areas of the body so heavily than just the lungs, and now I know why and how it is treated. I also didn’t know that in my lifetime, the life expectancy of CF patients has doubled from 18-25 to about 40! That’s really exciting news to me. I wish we had more of these lectures. Like honestly, if I had a lecture like this every single day, I would be very happy.

I’m not splitting up my learning into three parts this time because it doesn’t really make sense to. However, I have a ton of both academic and personal notes with me! I learned a lot today about transyouth and CF programs, and I also thought a lot about myself! And that’s the whole point of this shadowing program. It was a great day.

Oxy-CHLA Shadowing Day 3: PICU

Today I was in the Pediatrics Intensive Care Unit (PICU). Similar to when I was in the CTICU on Tuesday, this is an intensive care unit for incredibly sick kids. Different from the CTICU is that there are many older patients, several school aged children and even some teenagers, though there are infants and toddlers as well. Similar to my day on Tuesday, we rounded with the doctors and then we were allowed to split up and shadow some nurses. It was a pretty good day.

What I learned about the unit:

Sort of like what I said earlier, the patients in the PICU are very sick and are typically school-aged children. I saw patients with diagnoses from pneumonia, to trisomy 21, to paralysis in one extremity. The PICU gets all types of patients, instead of the specialized cardiothoracic patients in CTICU. Otherwise, the PICU functions very similarly to the CTICU. There was a lot more action going on, either because of just the day, or maybe it’s because more procedures can be done at bed-side with bigger kids. I got to see a 12-lead EKG (which I’m familiar with, but still), and an echocardiogram performed. I also learned about G tubes versus J tubes, and got to see a portable arterial blood gas tool. I also learned a good amount about ventilators today! Now I feel more comfortable reading respiration waves.

What I learned about the job:

Today I rounded with a fellow, two residents, a nurse practioner, and a pharmacist. Unlike CTICU, the attending was not with us on rounds. We didn’t end up going into any of the rooms (which made me sad because I really like seeing patients). However, I saw the fellow enter the rooms later. I ended up rounding with the main PICU attending, who was absolutely amazing. I would love to be a doctor just like her. She was very kind, funny, and even when she personally disagreed with the patient’s parent’s opinions, she hid it very well. There was definitely more doctor-patient interaction in this unit than in the CTICU, which is what I like to see.

Additionally, I got to see a little tiny baby admitted into the unit, and one of the residents did a physical exam on him, and also explained to me what to check for (such as fontanelles). I so very much appreciate any time the doctors invite into the room and then explain things. It makes the day so worth it.

What I learned about myself:

Hmmm… don’t know how much ICU suits me. I do love kids, but being at CHLA hasn’t bee like “WOW THIS IS WHAT I WANT TO DO FOR THE REST OF MY LIFE!” For example, the ER makes me feel that way. CTICU/PICU haven’t made me feel that same level of passion. I was telling one of the nurses, who figured out I was Filipino, that if I was never exposed to such hostile levels of Filipino stereotype (“All Filipinos become nurses.”), I probably would have opted to do nursing instead because of the amount of patient interaction. But whenever I think about being a nurse instead of going to med school, a piece of me dies inside because I want to study all the anatomy and physiology and pathology in-depth because that’s what I love. Also every time I think about switching to nursing, I literally cringe because it’s like falling into a stereotype I have fought so hard to go against and I could just see my family being like, “Ha! I told you so!” and no no no we cannot have that.

That’s all I’ve got for today’s post on my shadowing adventures at CHLA. Check back tomorrow!

 

Oxy-CHLA Shadowing Day 2: Medical Genetics

Today I had a late start. I didn’t have to get to the hospital until 1:00pm! I would be shadowing with a doctor in Medical Genetics. For those of you who don’t know, Medical Genetics is a branch of medicine (and genetics research) focused on elucidating the genes that are responsible for mutations or hereditary diseases. I was not super interested going into the unit, but in theory it seems very cool if you enjoy genetics or biochemistry.

What I learned about the unit:

Like I said, I came into the unit knowing nothing about how the unit functioned or even what they do! The doctor I worked with that day had a total of 3 patients to see, all of whom were not inpatients. Each intake session took about 45-60 minutes. The session included a counseling session to gain information about medical history and medical history. What I didn’t realize was how thorough this intake session was. There were questions like: What kind of pregnancy did you have (IVF or natural)? Any fever during pregnancy? Did you smoke or drink during pregnancy? How about months before? Are your parents alive? If not, what did they die from? There were just a ton of questions, and the genetic counselor was drawing the pedigree at the same time! I tried to draw my own pedigree but that was very difficult. After the initial intake, that’s when the doctor came in and actually looked at the patient (I got to see 2/3, and they were both less than 1 year old) and did a physical exam, making many measurements including head circumference, palm length, chest circumference, and palpebral fissure (eyelid) length. It was all very thorough. From there, the doctor speaks to the patient’s parents and suggests genetic testing if it was appropriate and took the time to answer any questions or concerns. It was very cool because the doctor just looked at the baby and was able to come up with multiple possible diagnoses.

What I learned about the job:

You’ve got to be familiar with a whole range of diagnoses! Yes, you have access to a computer, and the doctor told me about several databases he uses to help inform his diagnostic opinion. But the way he was able to just look at the baby and make some measurements and able to come up with several possibilities was very cool. This doctor took photos and documented every single patient in order to sort of archive them. Even if a patient has a confirmed diagnosis, it’s possible that signs may present differently. The doctor was very re-assuring to worried parents because it’s also possible that even with a diagnosis of a disorder or syndrome… it can be possible for the baby to grow up healthy and intelligent.

What I learned about myself:

While Medical Genetics seems like it would be cool to shadow in for like a week, I don’t think this is a unit for me. I’m more interested in medical issues that can be stabilized or cured as opposed to hereditary diseases or mutations. I was very interested just to hear about cases, but I don’t think it’s something that could maintain my excitement. I’ll be back next Wednesday anyway to learn about more cases so we’ll see how my opinion changes.

Oxy-CHLA Shadowing Day 1

Hello everyone! I have the fortunate opportunity to shadow at Children’s Hospital LA for the remainder of this week, and next week. Oxy has a great partnership with CHLA that allows about 10 students every winter and summer to rotate through several units to shadow the physicians and other medical professionals. I’d like to just reflect on my experience as the days go on.

Today I was in the Cardiothoracic Intensive Care Unit (CTICU)! I’m really interested in cardiology, so I was very excited to be able to shift through this unit. I’m splitting my reflections into three categories to help me organize my thinking (I do have to write a report at the end of the two weeks so this will be helpful).

What I learned about the unit: There were a ton of very tiny babies in this unit! For some reason in my head, I did not expect that… but it makes sense since many patients who require cardiothoracic surgery are babies with congenital heart defects. Several patients were just days old because they needed surgery as soon as they were born. Almost all of the patients had all these different tubes in them: intubation for ventilation (usually nasal, rarely oral), NG tubes, G tubes, central lines, PICC lines, etc. I felt really proud to know what all of those things were. I was able to learn why nasal tubes were more popular than oral tubes (which I’ve seen with adult patients): it leaves the mouth free so that babies can be soothed with pacifiers, and so they can develop the sucking reflexes, and therefore increases the likelihood of normal development regarding feeding and swallowing! One of the favorite diagnoses I was first introduced to today was dextro-Transposition of the Great Arteries (d-TGA). Basically, the aorta and the pulmonary artery are switched, causing a disruption of blood flow. As someone who was obsessed with the flow of blood since the age of 12, this was a very interesting anatomical deformity to me. I wish I could switch my comps topic to this.

More things I learned about this unit: pediatrics is a specialty, and CTICU is such a niche. As I followed the doctors on their rounds, I was noticing many differences between normal adult ranges for heart rate and blood pressure and blood glucose concentration, for example, and contrasting that to how peds patients are. One doctor told me that even at different developmental stages in life, and even the number of days after surgery,  the vitals can change drastically. It makes sense; I just never put much thought into it. I was just like, “Wow. Peds is hard.” You have to learn more than just what’s normal for one age; you need to know what’s normal at all developmental stages and a different of 10 points in HR or BP can really make a difference! And then dosage of drugs is also greatly affected by all of this too. It really put the unit into perspective.

What I learned about the job: When I first arrived to the floor early,  we walked in on morning report. Not wanting to disturb the team, we waited outside until it was actually our time to enter. After morning report was finished, a doctor let us into the physician work room again and introduced us to the group. We got to meet with other physicians and talked about ‘situational awareness.’ Then we also went over the patients’ X-rays. I wish I could have asked more questions, but I was very shy. Next, I followed rounds with the attendings, two fellows, and nurse practioner. The attending went into every single room except one to greet the patient as well as any family present, and did a very quick physical exam on every patient. One of the fellows let me tough the chest of a patient whose heart was dilated, and the NP let me use the stethoscope to listen to the heart beat of a tiny baby. It was nice to have these small yet meaningful opportunities. The rounding session was very different from the rounding I do when I volunteer. When the CTICU team rounded, it included a dietician as well as a pharmacist. Sometimes the cardiologists also got involved! It was all very organized though, and the participants always spoke in a specific order (RN, MD/DO, NP or MD fellow, comments from anyone, recap by RN). I will also add that this process took about 3 hours and my feet were killing me since we were just standing most of the time, and not walking. Definitely will keep that in mind, but props to the professionals who literally do this every day.

Something unrelated to the logistics, but I was able to ask one of the attendings about how to emotionally deal with a unit that could potentially be emotionally taxing. While many patients survive following surgery, there are patients who don’t make it. How do you deal when that patient is only 4 days old? It’s such a devastating idea! The attending told us that for her, she has a lot of patience for pediatrics patients because they often have conditions or circumstances that are not the product of their own choices. To contrast this, she gave the example of being in adult medicine trying to treat a patient who has lung cancer, but was also a smoker for their entire life. It’s hard to have as much empathy when you know that patient did that to themselves. However, children are innocent and therefore, she was able to have unending patience for them. Her willingness to help those children made the very few that didn’t make it okay. At the end of the day, she knew she did all she could in her power to help that person, and that it wasn’t because of unwise choices the patient made. I thought this was such an interesting perspective I had never thought of before. I’d really like to think about it some more.

What I learned about myself: I really like cardiology, but I wasn’t WOW’D by pediatrics. Maybe it’s because I literally didn’t understand 90% of what was said during rounds. It’s very hard to be interested in something you literally can’t understand. I still don’t know how I feel about pediatrics yet. I will be visiting PICU on Thursday where the patients are a little older so that might change my mind. A fellow did say he liked PICU over CTICU because he was able to interact with the patients more, and who knows. I might be the same way.

An irrelevant thing, but I also learned that I’m much more comfortable in hospital settings than my partner. Maybe it’s because I don’t have as much of a personal history, although it’s more likely because I literally am at hospital all the time. I felt pretty comfortable approaching nurses, NP, and residents about the patients or any general questions I had. I still felt very awkward around the attendings because I know they just have so much to do! It was nice to feel like I had a lot of confidence while on the floor. I was also super proud of myself for understanding a good amount of terminology despite very little exposure to it. Obviously I’m not in medical school yet, so I’m not expected to even be familiar with a lot of what was being said, but many of the terms were familiar! I think that was a big plus in having a really great time today.

Other than what I wrote above about the CTICU, we got to visit PICU to listen to an attending give a lecture to three residents about acute kidney injury. It was so intimate and nice, and the attending really took the time to teach the residents and test them on what they should have learned in medical school. I hope that my future attending is like this too, and I’m glad I got to sit in on that.

Day 1 at CHLA was a success! I can’t wait to learn more about the hospital as well as all the different units I’ll be rotating through 🙂

John Doe, 10:30am

The thing they don’t tell you on TV or in class about CPR is the incredibly low rates of survival even if CPR is performed within minutes of a person crashing. Less than half of all patients ever survive, in or outside of the hospital. And if they do, sometimes they sustain injury or pain.

The thing they don’t tell you is that even though you know that patient is likely going to die, that you keep pushing with unwavering faith that they might just come back. With each compression, it makes you believe in God or some other higher being to not allow that person to leave the world. That for the 90-120 seconds you are breaking their ribs, you just want them to breathe. You are their blood flowing through their body and to their brain. You are the one keeping them alive.

And then you turn around and see your team of MDs, EMTs, and RNs all exhausted from trying their absolute best to save someone who did not even have an ID.

A couple final shocks with the defibrillator and the doctor calls the time of death.

Dear John Doe,

I don’t know who you are. I don’t know if you had any family living, or where you came from, or why you ended up in the predicament that you did. But we still all wanted to save you and to give you a second chance in this world. We didn’t know your name or your story, but all the same we wanted to see you open your eyes again and breathe. I’m sorry we couldn’t bring you back, but I’m glad I was there to watch you breathe your last. We found you all alone, but you did not die alone. 

Marjorie

Goals for my Last Semester of College

Although these are technically long-term goals, I wanted to make these separate from my 2017 Goals list because they aren’t really “projects,” and they aren’t major “behavioral changes.” They’re mainly affirmations and beliefs that I know are conducive to taking care of myself.

  • Embrace my introverted self. As a senior, I’ve felt like I’ve had to go out often because it’s senior year. However, I rarely actually enjoy being out. I’m not the type of person who just likes to drink beer and chat, but you can’t even hear the other person because the music is so loud and no one is even dancing. (If dancing is involved, that’s a different story). Basically, on any given weekend, there’s like a 90% chance I won’t want to go out, and you know what. I’m okay with that.
  • Read for pleasure more often. I love reading, even if I’m not a fast reader and even if I don’t read a lot per reading session, I still enjoy doing it. I enjoy reading fiction, to nonfiction, to motivational books. I’ve moved on from YA I think (because now when I read those descriptions I’m just like… oh god the teenage angst!!!!) and now I’m more interested in literature. I would much rather spend more time reading than playing video games, which ironically happened this Winter Break.
  • Make more decisions that involve what I want to do. I decided on New Year’s Day that I was going to drop Avian Biology. The reason being that I wanted to be in the Emergency Room more often because I learn so much there (and frankly, I don’t get graded for it either). For awhile, I thought I had the obligation to have a full academic schedule since this is my last semester of undergraduate studies ever and let’s face it… when am I ever going to have the chance to just study birds? Probably never. But if I had to choose between birdwatching and assisting with a chest tube insertion, I would choose the latter. Every single time. Therefore, I dropped a class.
  • Spend less time worrying about grades. Do I even have to explain this? Honestly grades aren’t even indicative or predictive of my success. I have way more important things to worry about: my healthy, my long-term goals, actual people in real life, etc. Grades are minute. When I spent more time taking care of myself instead of slaving over my classes, I became a person who was much more at peace. I want to maintain this.
  • Reach out to younger students. Since this is my last semester, I want to be a mentor to students who might be like me: clueless first-generation college student who has no idea what to do (especially if it involves medical school). Something I enjoy is talking to students who are absolutely freaked out about grades because they are pre-med, and putting their worries into perspective. I wish I had a mentor like that. I had several professor mentors, but not a student. I want to be able to reach medical school and stay in touch with the students I may have mentored to show them that high achievement is possible, even when you enter undergrad with not a clue about how the system works.

So these are my goals going into senior year. I’m on my way out of school, which is really exciting. I’ll probably spend more time volunteering at the hospital rather than actually studying. But I’m okay with that.