Category Archives: 3rd year medical school

Life Decisions

Match day was a few weeks ago for the fourth year med students across the country, where they found out where and in what program they will be spending the next 3-6 years! It’s a day full of excitement for all med students as we can see the light at the end of the tunnel.

For me, and for some of my classmates, however it was a source of stress. In less than 5 months we will officially submit our ERAS application for residency spots in our chosen specialty field. There are several of us who are still undecided on what we are going to apply to! It makes it easier to know that there are people in the same position as you, when it seems like everyone is applying for away rotations and looking at what programs they want to apply to. I’m just walking around the hospital trying to figure out what I can see myself doing for the rest of my life.

This is when the incredible community of medical students shines through. When you look terribly confused or upset, there is always someone around the corner willing to help. It’s what I love most about my med school class. On a day where you feel like you’re in the wrong field, you’ll never be able to choose a specialty, or are on a downward spiral thinking you’ll never match, there is a friend right there to reset your thinking with positive thoughts. I am so grateful for the wonderful people that are in my class who help me through my semi-daily panic attacks on these large life decisions, because they are in the same place I am.

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There’s one thing I’m told over and over again… listen to your heart it already knows what you’re meant to do. Which is easier said than done. Mostly because there are so many factors to take into account when choosing a specialty – Do I have a competitive board score? Does it have the lifestyle I want? Can I raise a family? Would I be happy? Do I want to work with my hands or my brain? Do I like the OR? Do I like the clinic? Do I like the hospital? It’s a long, complicated soul-searching process. While it’s a journey each of us has to travel alone, we are never truly alone. On a daily basis I have med friends texting me with words of encouragement and advice.

Other truly wonderful are the attendings and residents at UTMC. Because one of my considerations is general surgery and my general surgery rotation was rather slow, a surgeon is letting me take my spring break week this week to work with him. A neurology chief resident sent me a long email all about the pros and cons of choosing neurology. The orthopedic surgeons were willing to offer any advice on choosing away rotations. A family medicine doctor told me to call her any time if I need any help with the application or choosing a specialty process. These doctors go above and beyond to help, and it’s something so special about UTMC.

So to everyone out there who is still unsure of where they belong, don’t fear. There are some of us who are with you! And to those of you who know what you want, congratulations!

 

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Cancer and Hope

There will always be days in medicine that are hard to swallow. Today happened to be one of those days.

Back when I was on labor & delivery I saw a pregnant woman who was a little worried about several issues. I did a thorough history, physical, and review of symptoms. One of the things she brought up was that she’d had a breast mass for a significant amount of time. Other doctors had told her that it was no big deal, just a duct enlargement and it would resolve after pregnancy. I, never knowing what’s pertinent or not, presented this to the senior resident (along with twenty other findings) who told her she needed an ultrasound and biopsy. She left that night. Today the senior resident told me the pathology came back as triple negative invasive ductal carcionoma. It is one of the most difficult types to treat and has a high rate of spread and recurrence. While I’m glad we were able to finally listen to her and start treatment, it makes me sad so many other people failed to listen to her. She’s a young woman with kids, and a life, and now cancer.

I also have a patient with metastatic endometrial cancer. We had to tell her and her husband that the chemo is not working and that, in fact, the cancer has spread. We’ve discussed the idea of hospice care at this point. That is never an easy conversation to have with patients and their families. She had kids, grandkids, a husband, a life, and now cancer.

I think there are so many skills we learn as medical students. But one of the most important things I’ve learned has been this year and that’s how to talk to people and how to treat people. On the gynecology service there are some really amazing attendings and residents. And yes, they’ve taught me how to do a good pelvic and breast exam, elicit information about patient’s personal lives. But what they’ve really taught me, especially on the oncology service, is how to be a GOOD doctor. And the key there is listening to your patients, and treating them as you would want your own family members treated. It means taking the extra ten or twenty minutes with your patient (or even an hour if you need to) to explain things to them, to make sure they understand what’s happening. It means empowering patients to be their own advocates and to be active participants in their care. It means holding someone’s hand before surgery and giving them a hug when they’re cancer free. It’s not always about the medicine – it’s about being a decent human being.

Unfortunately today cancer is something that you’ll have to deal with no matter what specialty you enter into in medicine. And the best advice I’ve ever been given was by an attending who said “never treat cancer patients in any way that causes them to lose hope, because hope is often the greatest medicine we have”.

So, never ever give up hope.

First Blue Stripe

ONE STEP CLOSER TO BLACK BELT.

There are a lot of ways to measure progress. In medical school we measure progress with tests and skills exams. In jiu jitsu, you measure progress with belt color and little tape stripes on the end of a belt.

Here’s what I think – I think progress is measured by the immeasurable. I think I become a better future doctor when I connect with a patient and earn their trust. When I learn to go beyond asking questions and doing a physical and get to know that patient as a person. I know I’m progressing when I can put everything together and come up with the next step.

In jiu jitsu, I think each stripe and each belt represent so much more than that. So how have I progressed? I’ve survived 1.5 years in a sport my coach says is designed to make you quit. I’ve learned not to give up. I’ve made some amazing friends who I know will always have my back. And I’ve become a part of something bigger than myself. I’ve learned to never let the everyday losses drag you down, because a win is right around the corner. I’ve learned that you probably will get your butt kicked from time to time, but that makes you stronger, not weaker. I know I’ve progressed because I can now step onto the mat and know it’s where I belong, not somewhere I feel out of place. And I know I’ve progressed because I’ve become a part of the Ribeiro family.

 

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You never notice progress in the day to day routine of life. You have to take a step back and look at how far you’ve come. Just a couple of weeks ago I delivered a baby – that’s absolutely incredible progress from the days during second year where I memorized pelvic floor anatomy. Each day in the hospital I progress more and more, and at the end of a rotation it always amazes me how much I’ve learned. And in jiu jitsu, you never fully appreciate how much your body learns every time you’re there. Then one day, after you’ve taken over a month off, you come back and your timing is off, and you can’t seem to do anything right. Then it starts clicking again. It always amazes me.

So, while you may feel like you’re not going anywhere, take a step back and look at the bigger picture. I’m sure you’re much farther along than you think. And if you’re working toward your dreams, you will make it as long as you never give up.

So thanks to everyone who helps me in my daily progress – my family, my best friends, and my Ribeiro family. I love you all! 

My Weekend Off

I know you’re all wondering what it is med students do on their free weekends, which I had this past weekend. So, here it is!

1. Sleep. A lot. Naps and probably 10 hours of sleep per night. Yes, naps was plural.

2. See friends. Especially non-med school friends who you may inadvertently ignore during a
imagetough rotation. It doesn’t matter what you do – you could go to dinner, go to a movie, go ice skating, or go see a bunch of girls you’ve known since grade school and just hang out. Whatever you do is bound to be fun, because it’s social and it’s out of the hospital!

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Back to RJJ Toledo!!!!

3. Work out. Which in my case meant I got to return to RJJ Toledo!! It was so great to be back training with my team. Saturdays are the toughest day at our academy, and it was full of high level guys pushing each other. I wish you could all experience how much fun it is to have a great training session with a BJJ family! Everyone’s training for the tournament this Saturday (which, sadly I can’t make it to because I’m working).

4. Shop. For new clothes (though nowadays this means less casual clothes and more work-appropriate clothes), winter boots, a winter coat, and heck we can throw a new purse into the bunch! I’m a binge shopper which means I *may* or may not have spent a LOT of money this weekend. Oops.

5. Stock up on your favorite caffeine source. For me, that’s currently Diet Coke. Meijer had aphenomenal sale where I got 36 bottles for $12. I think I’m stocked for a little while….

So that’s how I spent my free weekend. And today I started my OB/Gyn rotation! We had an orientation. I officially start on the labor&delivery floor on Thursday morning. I have 5 shifts in a row, two day shifts and three night shifts. We have to see at least 2 deliveries (and participate in one) and two c-sections in those 5 fourteen hour shifts. So that should be…interesting!

How’s everyone else spend free weekends? I like to think probably quite similarly.

(And for fun, this is apparently what ice-leaves look like when leaves freeze to your car).

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Life In Akron

I’ve been in Akron now for 2 weeks, and I’ve gotta say, it’s definitely growing on me. Before I left my parents and brothers thought I was crazy for choosing Akron over other options such as Columbus or Ann Arbor. I think it’s definitely been a good fit for me, in terms of life in the city. Unfortunately, the general surgery has been oddly slow (I’ve only seen 3 surgeries in 2 weeks) but I’ve still learned a lot! AND I even got to sneak in a morning clinic in ORTHO! Which was really fun, especially after a full day of hernias and hemorrhoids.  Finished the surgery oral exam, the OSCE, all that’s left is the shelf exam this coming Friday.

So, here’s life in Akron: (plus I got to visit my brother at JCU!)

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The first impression of the house they put med students in in Akron. It’s bad, I know. But don’t let it fool you.

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A view of my window from the outside.

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While I was here in Akron, I was lucky enough to get to train once at Top Level Martial Arts (http://www.toplevelmartialarts.com/) with Bill Jones. The class was really great – we worked omoplata from closed guard and variations of omoplata plus he tweaked my bread cutter choke a bit!

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Head instructor and owner of Top Level Martial Arts, Bill Jones. It was great to meet him and train with his guys. It’s really cool that no matter where you go, there will always be a BJJ family to take the edge off after a long day at the hospital.
If you’re ever in Akron, definitely check out his academy!

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Akron General is a really nice hospital! View on a beautiful fall day

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When I was on call at Akron, they gave me two pagers – one is a trauma pager. It was a lot like being an intern when they would both go off at once.

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A patient of mine in clinic told me about Ninni’s – an authentic Italian bakery where everything is made fresh every morning! So of course my housemate and I made a trip out there. It’s absolutely phenomenal.

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But I’ve got to say – the best part about coming to Akron was getting to catch up with my best college friends again who I hadn’t seen in over two years!!! 🙂

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More of my favorite Carroll friends! Both bio majors only, but I won’t hold that against them.

I will see you all back in Toledo this weekend! And then starts… OB/GYN!

Lessons from the SICU

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I know, it’s been over a month since I’ve posted. A quick summary, I finished orthopaedic surgery (and it continued to rock all the way to the end), I worked on the critical care team in the SICU for 3 weeks, and am now in Akron, OH doing a general surgery rotation. 

So everyone who knows me can say “oh not again” but I really do LOVE surgery. I love being in the OR and being able to fix someone hands-on. I can say this because for the past 3 weeks I was in the SICU, medically managing critically ill surgical patients.

What I learned in the SICU…


1.      Appreciate every single day of your life. We had young patients, we had older patients, but when the end of your life nears you aren’t going to care about anything other than whether you were happy and whether you made a difference. So make time for friends and family and for doing what you love.

2.       Make SURE you have end-of-life advance directives and you share those with your family. We had several cases of those wishes not being clear and it not only causes unnecessary prolongation of life for the patient, but gives the family a lot of hard decisions.

3.       I learned how to let people go. This may sound macabre, but there comes a point when a person isn’t going to return, when their pain and suffering is so great or their body has just shut down. While on SICU we had a few patients die – and you take each one personally for a while. But I also learned how to use that to push me to become a better doctor.

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4.       How to see the big picture. It’s easy nowadays in medicine with how specialized it is to get bogged down by the details of what you’re best at. For example, for most of our patients we had to consult nephrology, cardiology, and neurology. Each of them make recommendations based on the problem they see. But at the end of the day someone has to be able to integrate all of the recommendations and do what is best for the patient. It’s not just about one thing – it’s about everything.

5.       And finally, I learned the most important thing is to be yourself. The patient’s (especially in the ICU where there are limited visitor hours) need someone who will just say hi. The residents and attendings have a lot to worry about and do for each patient. You definitely can help, but don’t try to be someone you’re not. I knew I was really good at doing TPN orders – so I did those every day. The fourth years took care of putting the orders in. It’s about knowing your strengths and being part of the team.
   
    I also learned from an attending that I need to tie 1000 knots daily to be a great surgery. I’m actually trying to tie that many! I can now do about 100 two handed square knot ties in a few minutes without even looking. It’s great! 

I’m still trying my hardest to make it to train at least once or twice a week. Some weeks when I’m working 80 (or more) hours, it’s tough. But my Ribeiro family always welcomes me back to train with seriously tough matches, making me better even though I can’t be there often.

An update soon on life in Akron! 

Real Medicine and Teaching BJJ

Quick med school update: I officially started working in the clinic/hospital and I LOVE it! I actually get to put the years of knowledge and skills we’ve gained to use. And the patients are wonderful about it, and the physicians at UTMC are incredible mentors and teachers. I’m currently in neurology, a specialty I thought I would never be interested in, and actually am seriously considering a future in it. We’ll see what happens!

Jiu jitsu: One of the greatest things happened a few weeks ago: Chris (my coach) asked me if I wanted to help out with the teen class. Quite honestly, I think that’s better than any medals I’ve won or stripes I’ve gotten. I see it as trust that Chris has in me and that he sees that I’m improving enough to help teach and help coach the teens. I’m so grateful. Well first, because now I get additional classes in, and second because you learn so much more when you have to help show a move or coach kids through it. I absolutely love it. (But then, I’ve always loved teaching: I was an assistant dance teacher in high school, a teaching assistant for chemistry in college, and now I get to help with jiu jitsu!) I feel incredibly lucky and honored to be given this opportunity. Plus, the teens are the closest to my size, so getting extra training in with them is really helping me out, probably more than them some days.

We have a tournament next weekend, and I’m excited! It will be my first tournament at blue belt, and a bunch of my teammates are also competing so it will be a great day. Win or lose, we’re all out there to learn where our strengths and weaknesses are and to improve our jiu jitsu! Taking home a medal is just a bonus.

I found this quote by Marcos Souza, and I thought it summed up everything I think those in jiu jitsu should know, so I’ll leave it here:

None of this lasts long: the fights, the gold medal and the prize money. The medal will rust one day, the fights will be remembered by only a few people and the money is almost gone. The most valuable thing in Jiu-Jitsu is the opportunity to live special moments forever. Whether at breakfast, a hotel, in practice all together and even in the sauna, in every corner you have fun. The friendship and the good times last forever. The rest is fleeting, there are people and moments in Abu Dhabi that I will carry in my heart forever. Some people don’t really know what Jiu-Jitsu can do in your life and give more importance to be the champion or to a simple gold medal. Another important lesson: if only a few believe in you, fight for the few who believe. It is for them that you should give your best, no matter what others say. The dream is yours, chase it.

So, GO CHASE YOUR DREAMS!