Fourth Year Interim Summary

Wow. It’s been a really long time since I’ve written. What’s happened in the interim? I finished my 3^rd year of medical school. I took and passed step 2 CK and CS of my licensing boards. I started fourth year, and have finished 3 full months of surgery electives. And finally, I applied to residency programs!

My second surgery month was an away rotation on a surgical oncology elective. I couldn’t wait to wake up at 4am every day because I loved the hospital, I loved the surgeries, and even more I loved my patients. They kept me coming back each and every day because they were the most hopeful, motivated, and some of the greatest people I’ve ever met. I worked hard, but I also got to enjoy some days off to see the city.

Two of my days off I had the privilege of training jiu jitsu at the Relson Gracie academy with Robin Gieseler. The guys and girls there were extremely welcoming and I had some really tough matches! It was great to be back on the mats, even if only for two days, after being away for so long. Visiting a new academy is always a fun and challenging experience, at least from what I’ve found. Everyone has a different game they like to play, and it’s always good to have your game challenged by a completely new partner.  I found a surgical specialty that I quickly fell in love with, because as you’ll recall I loved my oncology rotation during my medicine rotation as a third year medical student. Surgical oncology combined the best of my love of surgery with a love I have for helping cancer patients once again find hope.

Right now, I’m writing this from my couch in KY where I am currently on a trauma surgery elective. I can honestly say I have never been so busy in my life. We consistently have a patient census of greater than 60 patients who we round on and take care of every day. It has taught me great management skills and organization. It’s quite the change from to the fast paced world of trauma surgery, but I have learned so much! Trauma surgery is high paced, intense, and so much fun! 

 Tomorrow  I’ll be heading home to Toledo for the rest of the year. I’m excited to get home to my family, my friends, and my jiu jitsu family. I’ll start going on interviews for residency as well. It’s a year of firsts and lasts and it’s already flying by! Every day I am so incredibly grateful to be on this journey, sometimes I can’t even believe how lucky I am.

My (In)Glorious Return to BJJ

Since the start of third year of med school I have been extremely inconsistent with my BJJ training. In part because of long hours with studying piled on top of that and also in part because I have awful time management skills. Add to that the months I’ve been away for rotations, the times I was sick, and the times I really did work until 10pm and you’ve got quite a disjointed training schedule.

I just came back from a 3 week break while I was on a rotation in Michigan. And when you return to BJJ, here are the top things you notice:

The first thing you notice when you get back is how much you’ve missed your BJJ family. You walk through the door and are immediately met with mixed greetings such as the sarcastic “oh, first day? Here, I’ll show you around” or “you guys remember Meghan, she used to train here forever ago” to the genuine “welcome back! We’ve missed you” or the “Meghan’s back!”.  And you appreciate each and every one of those, because you know you’re truly part of their family if they’ve got enough sense to mess with you.

What’s the second thing you notice? You inevitably forgot something because you’re bad at packing your bag. Belt- check. Gi-check. Sports bra-check. Fight shorts-check. Rash guard-dang it! Luckily you always keep an extra set of gym clothes in the car. Hair tie-shoot! Good thing many girls train, you snag an extra from one of them. You’ll get better again with practice.

The third thing? You really didn’t “forget” much. You still remember how to move and while you’re drilling you’re breaking free some of that rust in your brain. But DANG are you out of shape! It doesn’t matter that while you were gone you were running 4-5 times a week. BJJ in-shape is an entirely different animal. And you, my friend, have not tamed it (kind of like your hair at that moment, you’ve gotta remember how to keep it from looking like a wild monkey attack).

The fourth thing? This is my favorite. Sure, you’ve been gone for a while, and sure you’ve been inconsistent with your training, but when you start that first match during open mat it doesn’t matter because muscle memory kicks in. And yeah, you’re a little ‘white belt spazzy’ all over again, but hey – you’re pulling guard and sweeping and getting out of mount like you haven’t missed a beat (until the guys pull out their new tricks and you find yourself in an uncomfortable submission and remember the humility in tapping).

So overall, a return to the mat is never without its flaws, and it may not be the glamorous return like a movie star to the silver screen after a break, but hey – if you can keep coming back you’re well on your way to black belt. Because if you’re crazy enough to ENJOY getting beat up on a daily basis and actually WANT to go back after a break, your mind is set on the path.

Like my coach says, you’re either one day closer to quitting or one day closer to black belt! (Spazzy inglorious blue belt return and all!)

Thanks to all my favorite teammates for welcoming me back then showing me my game needs a lot of work 🙂

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.

❤

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!

 

Family Medicine

Study break writing time!

First, let me say that family medicine has exceeded all my expectations and has surprised me more than any other of my rotations. I have met who I consider to be some of the best doctors on this rotation. And because of that, I began running a little mini survey. I decided to find out what makes these doctors so great. I’ve polled patients, the nurses, fellow med students on rotation, and even the residents and attendings. I’ve asked what they think makes a great doctor.

Here’s some of my favorite quotes:

Patient – “I think Dr. X is a great doctor because I feel like I can tell him anything and he will actually care enough to take care of it or send me to someone who can. He’s the first doctor who sees me as a person, not their 10:30 HTN recheck”

Patient – “You know, I’ve got 6 different doctors for all my problems. And I won’t say that Dr. X is the smartest one cause you know, those cancer doctors are really smart (here I just laughed). But I still think Dr. X is the greatest doctor of them all. (I asked why?). Why? Well because she respects me and I respect her. And mostly because every time I see her she’s smiling and happy to see me. That means a lot.”

Nurse – “I’ve worked at a lot of different clinics throughout my 30 years as a nurse and trust me when I say I have never worked with a better group of physicians. It’s everything from the way they treat the nurses as equals to the hoops they’ll jump through to help patients. You can see that they genuinely love their job and their patients are important to them.”

Resident – “What stands out about the attendings here is that they are constantly learning the newest treatments and management plans. They want to be sure their patients are getting the cutting edge care. Most of our patients are Medicare/Medicaid/uninsured but never has that made the attendings treat them any differently. They are amazing doctors because they see every patient as equal and strive to give them the best care they possibly could receive (even the difficult patients).”

So what I’ve learned most from my family medicine rotation (which is saying something because I am really great at HTN, DM, HLD, hypothyroid, COPD, and musculoskeletal problems now) is that the key to being a GREAT doctor is to love what you do. The love you have for you branch of medicine will show through in your day to day life whether that’s in the hospital, the OR, or the clinic. Patients, at the end of the day, want to feel cared about. They don’t care if you’re the smartest or the most well-known or whether you are a neurosurgeon or a PCP – they just want you to care about them.

So a big THANK YOU to all of the amazing residents and attendings on my family med rotation who have treated this med student not as a nuisance, but as a vital member of the team. My opinions and plans have actually been put in place, everyone makes sure I’m learning everyday, and everyone has really made the clinic feel like home to me.

Just two more days left in family, and it’s going to be sad saying goodbye to such a great rotation!

Downtown Toledo as seen from the clinic!

Valentine’s Day love from Medicine

 

Happy Valentine’s Day to all those medstudents spending it in the hospitals/clinics! Because abscesses, boils, URIs, HTN, DM, lap choles, appis, well care checks, strokes, hysterectomies, and femur fractures mean just another day for us! Which, let’s be honest…. we secretly love.

So for those of us who’s true love is MEDICINE, happy Valentine’s day from medicine 🙂

Fall in Love

To all third years deciding what they want to spend the rest of their life doing:

Nothing is more practical than finding God, than falling in Love in a quite absolute, final way. What you are in love with, what seizes your imagination, will affect everything. It will decide what will get you out of bed in the morning, what you do with your evenings, how you spend your weekends, what you read, whom you know, what breaks your heart, and what amazes you with joy and gratitude. Fall in Love, stay in love, and it will decide everything.

                        -Fr. Pedro Stripe, S.J

Fall in love with a field and you’ll never work a day in your life.

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.

 

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
tough 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!

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).

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!)

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.

A view of my window from the outside.

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!

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!

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

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.

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.

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!!! 🙂

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!