Oh, she's just being Miley!

Apparently smiling is not allowed on surgery. That, or surgery is going to beat the smiles off my face.

What can I say, I'm a smiley person. The original s'Miley Cyrus, if you may. So on my first day on surgery, I walked up to my assigned ENT attending, smiled, and introduced myself.

ME
Hello sir. Dr. Shah? I'm Michelle, your third year med student.

DR. SHAH*
[never making eye contact, and muttering all of this under his breath]
Okay okay that's fine. Just stand over there. We don't have any patients yet.

I nodded and pulled out my Surgery Recall book to peruse. I saw an empty chair and sank down into it. Heels, after all, are no walk in the park.

DR. SHAH
[still not making eye contact, and still muttering - to the point that I'm not sure if he's talking to himself or addressing me]
No no, students don't get to sit. Chairs are for attendings. Walls are for students.

I jumped up, making way for the invisible attending that was to sit in that chair. Or the three other empty chairs nearby.

I eventually got my first patient, did a crappy H&P job (seriously, what questions are you supposed to ask beyond how are your ears/nose/throat?), and went with the patient to the mini sinus CT scanner.

The scan finished and I went to go find Dr. Shah.

ME
[smiling per usual]
Oh, Dr. Shah? The scan's done.

DR. SHAH
And what did it show?

ME
[smiling still but nervously now, because I've never read a CT scan on my own in my life]
Um. There was a patent airway, nasal and orbital bones were intact --

DR. SHAH
[cutting me off]
Don't give me that A-B-C crap you learn on medicine. What were the pertinent findings?

ME
Haha, um --

DR. SHAH
Why are you laughing? This isn't funny. Be a doctor and tell me what was important.

ME
[no longer smiling]
I believe there is some residual mucus in the sinuses

DR. SHAH
Which one? ALL of them? Just one? Damn it, use medical terminology.

ME
Um, I believe it's not the maxillary or frontal or sphenoid ones.

DR. SHAH
So it's the ethmoid sinuses. I didn't realize we were playing a game of 'not this but that.'

ME
I'm sorry sir.

DR. SHAH
You should be. Don't waste my time.

Needless to say, I didn't smile the rest of the day, for fear of being yelled at. It's going to be a long three months.

* Not his real name, of course. Because he hates me. And smiling.

Shawty what ya name is

ME
Aww, this is kinda sad. Dude, remember you're not poachable when you go to USC okay?!

MARTIN
[looking over]
Hahahaha!! Don't worry I'm not that hot.

ME
[glares]
...

MARTIN
I mean I love you, you're wonderful, and I will not be poached.

ME
Yeah. That's right.

MARTIN
Yeah, and I'm a shorty.

ME
Hahaha, you are!! But you're my shorty.

News update #2

Martin's going back to SoCal!!! USC NEUROSURGERY BABYYYYYYY!!!

Thanks a lot for going back to such a competitive area - makes it so much easier to follow you...what do you have against South Dakota anyways??

Will update with more match stuff after my ob/gyn shelf. Because now I really have to do well.

Cut it, ya match it

It's the week of The Match. Monday is the scramble - the day fourth year med students find out if they have matched into some residency program. And if not, they spend that day faxing resumes and letters of recommendations to programs with open spots, just praying for a job of any sort. Then, Thursday is the MATCH, when students find out where they are spending residency.

I've been stressing out about this Thursday more than anything. Because not knowing where Martin's going seems more stressful than knowing he's going to a location so competitive I won't be able to follow him in a year. I know, it doesn't make all that much sense. But the unknown is always scarier!

Anyways, Martin is kind of a superstar. President of the class, founder of this or that club, good grades, good scores, awesome boyfriend. I've never worried about him matching at a top program, much less not matching at all. However, Martin worries. And whenever Martin has voiced fears about the match, I've always rolled my eyes. I mean, seriously, it's like Johnny Depp worrying that he won't be a good actor playing the Mad Hatter, even though it's just a crazier nonsensical version of the Willy Wonka character he's already pulled off. Or Steve Jobs worrying that he won't make a ton of money off of gadgets merely by putting an "i" in front of everything - iPod, iPhone, iTouch, iMac, iHome, iPad. Or me not finishing a tub of ice cream in one sitting.

It's now Sunday - the day before the Scramble - and Martin bought me a huge tub of ice cream because of my especially black cloud of an obgyn call.

MARTIN
[earnestly]
I need you to tell me that I'm not going to scramble tomorrow. AND DON'T ROLL YOUR EYES WHEN YOU TELL ME.

ME
[just as earnestly as him]
You're not going to scramble. Seriously. Why would you even think that?

MARTIN
But what if it's a FUBAR?!

ME
What the heck is a FUBAR?!

MARTIN
Fucked up beyond all repair.

ME
Hahaha! [seriously] Martin, you are NOT a FUBAR. Not even close. I saw a woman with fourth degree lacerations today...when we went to assess her cervix, we pulled out fingers contaminated with poop. That's a FUBAR.

Martin
[going back to his work]
Hahaha! That is FUBAR!

ME
Hey! I'm not finished!

MARTIN
But I feel better now! I am reassured!

ME
Let me finish! Look at me! You are not a poo-filled vagina!

He really isn't. Still, I will keep everything crossed for him that he doesn't have a FUBAR and have to scramble tomorrow. Even if I will roll my eyes while doing so. While eating my giant tub of ice cream all in one sitting.

News update #1

Brief news update! I'm going to Jamaica on an NU-AID trip at the end of this school year!! So excited! :)

Baby makes three

I stared at the pregnancy test. "Heidi - is it just me, or is there a line there?" The indicator line was super dark indicating that the test was working, but there was a faint line next to the YES. I swear I wasn't imagining it, but I was trying to will it into existence, too.

I had just spent thirty minutes with a couple going over the preconception talk. They were super cute, wondering what strategies there were to get pregnant faster, or what diets they should both be on for super fertility. At the end of it all, I asked her when her last menstrual period was. Um, February 5th? I stared at her.

ME
Do you remember how long your cycles were before you started the pill?

WIFE
Um, I think I was pretty normal...like 26 to 28 days maybe?

HUSBAND
[putting the pieces together, eyes bugging out]
Do you think we're pregnant?!!?

WIFE
But! That's not possible is it?! I've only been off the pill for a month!

ME
Well, how are you feeling?

WIFE
Well...I think I have a cold - I've been feeling really crampy and I have some abdominal pain....OHMYGODDOYOUTHINKI'MPREGNANT?!

ME
Well, since you're here, why don't we go ahead and do a pregnancy test? Did you leave a urine sample?

WIFE
Yes. Yes I did!

I excused myself and went to go squirt some of her urine onto the pregnancy test card. And here we were, with a faint barely discernible line. I called over my preceptor who looked at the card and told me I wasn't imagining anything. The pregnancy test was positive. She walked over to the conference room where the couple was waiting. But halfway there, she turned around. Wait - you should do the honors! I stopped in my tracks, flabbergasted. Go on. Go tell them they're pregnant!

So I went. And I told them. And they didn't believe me for five minutes, repeatedly asking me if I was just joking, and if I knew what a horrible joke this was. I promised them that I wasn't lying, but to be sure, we wanted to do a blood test. They looked at each other, grinning and internally freaking out. The wife got up to follow me to the lab. And then the husband stopped her, turning to me to ask, "um, would it be weird if you gave us five minutes to process this first?" I smiled and left the room, closing the door behind me. The door had barely clicked closed when they started screaming and yelling. I had no doubt that behind that door they were jumping up and down.

It was exhilarating. It was amazing. And it was so so joyful.

PS I don't want to be pregnant. But I love seeing other people who want to be pregnant, find out that they are.

Superdate (aka Megadate)

I love gooey and romantic!

Near life experience

Wow, what a night huh?
Seriously. Tell me that you at least got to be in one happy delivery today.
Yeah, but I was still preoccupied the whole time.
I feel you. Tonight was rough.
For real. It was sandpaper-your-face-and-let-it-weep-with-blood rough.
Yeah.
Yeah.
Sigh.

On my last night on night float, I saw the other side. The unhappy side of L&D.

I should have known. I walked into the hospital at 6pm, into a very sober sign-out, where the day team was debriefing about a mom who delivered twins, knowing that one of them was a trisomy 21, had been leaking amniotic fluid, and probably wouldn't survive for more than a couple of minutes. The mom didn't want anything done for that baby. She had come to terms with it, and she made it clear that she wanted at least one healthy baby. So when they did the emergent c-section, they delivered the first twin, and with Apgars of 1 and 1, there was no intervention. Yet, looking at the baby later, the first twin didn't have any of the classic features or facial abnormalities associated with trisomy 21. Did we make a mistake not trying to resuscitate? Had we misdiagnosed the trisomy? And if so - should we have performed a c-section weeks ago, when the first twin might have had a better chance at survival? Would any of it had made any difference?

As we grappled with those questions, we got a heads-up from an outside hospital - they were sending us a patient who hadn't felt fetal movement in 2 days and had finally decided to come in to the ED to get it checked out. The baby had died. And now it was our job to counsel the mom and perform a c-section. It was the worst hour of my life. Knowing in advance that you're delivering a dead baby doesn't make it better. If anything, it makes it worse. Way worse. We made the incision and tried to push the baby out, but because there was no tone, it was so difficult. And very sobering. The mom cried the whole time. All I wanted to do was walk over to the other side of the drape and hold her hand, but I was stuck there, holding her bladder out of harms way, watching my resident and attending try to wrestle that baby out of the uterus. And when it was all over, my resident and I walked back to the conference room, and we both broke down too.

You would think that it couldn't get any worse. But bad things always seem to happen in 3's and at 4am in the morning. That night wasn't any different.

At what seemed like 4am exactly, we got a call from our own triage team. A 23-week first time mom had rushed to the hospital because of lots of vaginal bleeding and fluid. Chaos reigned. The senior resident tried to put on the fetal monitor and figure out a pattern to all the decelerations we were seeing. Another resident was trying to pull up past notes on the computer but the entire system was freezing, for some odd reason. The intern kept paging the patient's attending, and got no answer. The nurse kept taking vitals every 15 minutes. The anesthesiologist kept trying to place an epidural, but the patient was in so much pain she couldn't sit still. The students ran in and out of the room, fetching things. Ultrasound machine. Boluses. Steroids. Booties. A different attending ran into the room to help. And the husband sat there, bewildered, silently putting on scrubs that we handed him, as we prepped his wife for emergent surgery. And none of us knew what was really going on.

They had just gotten into the operating room when the baby's heartbeat flat-lined. The students were sent away, so we instead waited anxiously in the conference room, pretending to write notes and do work, but all of us preoccupied with what was going on in the OR.

The baby didn't make it.

It was 6am by that time, and my fellow M3 teammate and I were sent home. Normally we rush home, trying to beat the sunrise, trying to get in bed while it's still semi-dark. But that morning we didn't rush anywhere. Instead, we sat in the locker room, in our blood and amniotic fluid-stained scrubs, trying to digest everything that had happened. Trying to figure out rhyme from reason. But there was none. There was no meaning in all the madness. No karmic explanation. We eventually fell silent and ended up sitting there with our backs against our still-unopened lockers, numb from all the pain we'd seen that night.

It was a rough end to L&D. And a rude reminder that bad things always seem to happen to the nicest people.

My pulse is racing, I can't catch my breath.
This near-life experience scared me to death.
Is this where I end, or is this where we begin?
Or is this where we begin?
- Lifehouse

Baby be mine

Being on night float has been an emotional roller-coaster. Maybe it's something about going to work when the sun is going down, and sleeping through the day, but it's been pretty crazy and twilight zone-like. Maybe it's been all the postpartum happy hormones, but I feel like I have a constant smile on my face. And, maybe it's because I've been around a lot more women, and the estrogen levels are getting to me, but I feel everything more intensely, if that makes any sense.

Yes, labor and delivery has been amazing.

I love being there and interacting with these soon-to-be parents.

It's nice being there for the patient when she's getting her epidural, especially since the anesthesiologist chases the husband out of the room to create a sterile environment. Which makes absolutely no sense to me - as long as I wear a hat and mask, I can be there so my patient can squeeze my hand as hard as she needs to, but the hand she truly wants to hold has to wait outside the door? It makes no sense, but I'm thankful for that time, because it allows me to bond with my patient.

It's fun cheerleading for my patient, telling her to push through the pain and go! go! go! And it's fun helping her breathe when the husband gets too excited and starts breathing too quickly for her to follow.

It's absolutely heart-warming to watch the parents see the baby for the very first time. It doesn't matter if the med student (me!) forgot to wipe the blood and poop off of the baby before handing the baby to the mom. It's crazy - that unconditional love. Seriously, have you seen a newborn baby? They're not cute. They have coneheads and they're pasty, and they look like little old men. Yet, something triggers that parental instinct and the parents inevitably start cooing and telling that baby just how much they love him. It's beautiful.

And I must admit that if the dad tears up, it's a surefire bet that I'll start welling up too.

Which is no good, because it fogs up my goggles and I have trouble seeing where the sutures are and what I'm supposed to be retracting and wiping. And then my attending laughs at me and tells a nurse to wipe away my tears for me. But it doesn't matter and I don't even get embarrassed, because I just helped bring a baby into the world! (Okay fine, I get a little embarrassed, but whatever.)

So with the 20 baby boys and 3 baby girls I delivered last week (seriously, what is up with that gender ratio?), I've come to realize that I love Labor and Delivery. Can I please do a residency in obstetrics, without the gynecology?