One of my surgical attending is intimidating and intense on service, but then says things like this

"I don’t care about what grade you get on this rotation. I just hope that throughout your 3rd year, you remember why you’re here and approach all your patients with compassion. Treat your patients like your family. You’re getting up at 3am to go to the hospital because that patient is your mom… It can get tough, there’s going to be bad parts to every rotation, but don’t let that bring you down, don’t let that stay with you. Take the best parts of everyone you meet, appreciate them, let those stick with you, and develop your own style from there."

He’s totally and completely my attending crush/role model forever xoxoxoxoxoxoxoxoxo.

Random stuff from the middle of surgery in the middle of winter

• Something I’ve learned recently: seniors including attendings, fellows, and residents are not necessarily right and if you have a different thought, you should speak up for yourself (nicely but still persistent) for the patient’s sake and for your own sake.
• The more I go through 3rd year, the less sure I am about what I want to go into. There has to be a balance between doing what you like and the lifestyle you desire. I like surgery, but I hate the lifestyle of most attendings I see and the patient populations I’ve encountered. But today, I was made aware of the nice lifestyles and the healthier populations that some specialized surgeons encounter (e.g. breast oncology surgeons, endocrine surgeons). I also love that it’s not just about the surgery, but to be a good breast oncology/endocrine surgeon, you need to be strong in clinical medicine—deciding when to cut/not to cut, when to biopsy/not biopsy, what alternatives could be better, and working well with multiple specialties. I want to follow a breast oncology surgeon for a day before my surgery rotation is over.
• I used to go to sleep as a child dreaming about the awesome life I’ll lead when I grow up. Now that I’m relatively “grown up,” I dream less and think about what’s important less. I’ve been pretty unhappy recently, being on surgery rotation in the middle of winter notwithstanding. I hope to find that child inside of me again.
• I’m excited to finally find a Chinese speaking drama that’s enjoyable to watch (我的自由年代). I can finally improve my Chinese in a fun way…I can now watch the most recent episode over and over obsessively while waiting for next week’s episode without feeling guilty hehe.
• Remember that when life is hard, when it feels like you’re just suffering all the time and not enjoying enough, remember why you’re going through this for, why you’re here—remember your long term goal. Remember your dream.

Medical Student Perspectives: How relationships in medical school will make you a better doctor

…the best advice I can give for relationships in medical school is to really have them. By “really,” I mean honestly putting your heart into them…I’m referring to all of your personal relationships…Your family and close friends will understand if they’re put in the back seat, or if the quality of your exchanges changes. True bonds are difficult to break. However, for that reason alone, they deserve more of you…Relationships help you reflect on a personal level, making your compassion more human, and develop the values you will rely on during your career. Surely, you will learn the most from your patients, but patients need someone with whom they can relate.

Here’s a sappy, feel-good (must read) article to offset the bitter, ranting post I made a few days ago…

Link: Medical Student Perspectives: How relationships in medical school will make you a better doctor

Ways to save money in medical school or other tight times

In light of increased discretionary spending for my good friend’s wedding as one of her bridesmaids, which I’m more than happy to do but that doesn’t change how strapped for money I am, I’m trying to find more creative ways to save money and still have a life. Here are some good ones I found on a simple google search (in no particular order)—

1. Sign up for membership at stores you frequent whether it’s grocery stores, convenience stores, department stores, clothing stores, etc.
2. Always bring your student ID in case you can get a student discount.
3. Eat at home.
4. Pack lunch & snacks everyday.
5. "Textbooks 2.0": online, electronic versions; renting textbooks; borrowing from/exchanging with friends
6. Shop at thrift shops.
7. Set a limit on how many times you can go out per month. Mine will be 3x/month. Maybe I can cut down to 2x/month.
8. Exercise whenever possible. Whenever I find a free slot in the schedule, I’ll go to the gym. There, less chance of spending money and at the same time it’s healthier! (Tip thanks to Jimmy Ng.)
9. Pass on watching movies in theater. Rent some movies from Redbox you’ve been meaning to see but never got to before they stopped showing in theaters…for 1/10 the price!
10. "If you save your change, at the end of the year you can take it to Coinstar and exchange it for a gift certificate without paying the fee they charge for changing to cash - Amazon.com has everything you could want to buy for Christmas presents." #
11. Learn how to take advantage of the Shell gas station Giant grocery store gives you! And other savings programs like this.
12. "Do all my shopping in one trip every three weeks. Fewer trips means better planning, less impulse buying, and less gas use. I make a list of what I need and stick to it UNLESS there is something I KNOW I will use that is seriously on sale. I also know which stores have the best prices on the things I buy regularly." #

# Tips thanks to Ohio State University School of Medicine Financial Services website.

Hope this is helpful for you! I will personally try to work on 6, 7, 9, 11, and 12.

Okay, I cannot end this post without a mini-rant:

To friends/acquaintances of medical students: please do not peer pressure us into spending more than we want or waft away our worries of being in debt with your thoughtless, “oh you’ll be rich doctors soon and pay off all your loans soon.” Yes, that will come (more) quickly for those of us going into radiology/anesthesiology/ophthalmology/dermatology but some of us will be filling the much demanded posts of primary care and will still be paying off our loans 10 years down the road… Please take your head out of the sand and read all the reports on how investing in medical education has one of the worst pay offs around. Also, realize that we’re not in debt for the 4 years of medical school, but at least 7 years because we still have residency afterwards where we get paid barely enough to keep ourselves alive much less start paying back loans. Unless you’ve been in our shoes or similar ones and know the feeling of watching your interest accumulate and compound year after year while knowing that you won’t even have a chance to do anything about it for another 5 years, please be more respectful of our financial decisions. And if you treat us to dinner or help us pay for something, trust me, we’ll remember and that generosity will be paid back to you 100-fold. Karma.

To other medical students: don’t let people who don’t know what they’re talking about peer pressure you. They’re not paying for the decision you make, you are.

Pimping

Rotations started last Monday. Been 1 week. Some thoughts—

• There’s so much…I don't know. I recall the keynote speaker at our clinicians ceremony saying that the firehose of info that’s been fired at us first two years has now been turned to full blast. I recall thinking that’s hard to believe. I confirm now that’s totally true.
• My first rotation is internal medicine. Sure, there’s a ton to be learned from it, but I don’t know if I'm in love with it as much as I thought I’d be. Maybe emergency med or OB/GYN is right for me?
• I'm frustrated that I can’t remember facts much less speak up quickly on rounds…I don't know. I need to review more? I need to stop overthinking? I need more quality rest time?

Final thought of the day: So I got brutally pimped today. I knew my info, but the amount of detail the attending asked of me was the level of a fellow—the senior resident told me so afterwards, and even the attending at the time acknowledged it, but he did it anyway. Now I know hyperthyroidism & Graves’ disease like the back of my hand. However, as prepared as I was, there are things I wish I did differently today—and it’s always the same—be confident in the things you do know. For things you don’t know, don’t be afraid to say, “I don’t know.”

"Clinical Judgment"

So much of clinical judgment is subjective. It doesn't just encompass making difficult decisions based on evidence based medicine and undeniably correctly interpreted results/physical exam findings/history, it also encompasses the actual interpretation of the aforementioned… how much epigastric pain do you believe he’s really having if he’s eating so well? Did he really have a 40 lb weight loss over 1 month if you had to dig that info out from him, and even then you had to ask if his belt & clothing size changed to assess how much weight loss he had? This is why no amount of evidence based medicine and technology will ever replace physicians, and why we have to be so careful about who we give the privilege of becoming physicians to..

Stress

= cortisol = me. Yeah!

Symptoms and effects of hypercortisolism

• Facial acne—def have this right now…
• Fat redistribution, e.g. truncal obesity, thinning of extremities, moon facies
• Hypertension—scared to check mine
• Immune suppression—better not! cannot risk getting sick before the big ole exam
• Osteoporosis
• Abdominal striae
• Hyperglycemia
• Emotional disturbance

^Self portrait. Jk. Obviously, my situation is not that extreme. People who have some constellation of these symptoms usually have something more serious going on—adrenal hyperplasia, pituitary adenoma, cancer somewhere that’s secreting ACTH as part of a paraneoplastic syndrome, taking steroids as treatment for another disease, etc.

So, too much stress is no good! …Yet not enough cortisol isn’t good either…it’s what keeps you alive after a stressful event like an illness, surgery, or trauma. So it’s not much different from what we learned in middle school about emotional and physical well-being, haha. I swear, we learned everything important about life in elementary and middle school.