MINDFUL OF MEDICINE

My life has been a series of checklists, each completed in a deliberate and timely manner. Ever since I can remember, my goal was to become a physician. It was a calling and an autonomous way to help those who need care and healing. I also knew that it required hard work, dedication, and planning. In middle school I knew I had to find a high-performing high school to attend. In high school I knew I had to do well to get scholarships to afford university. Starting university was one of the biggest chapters of my life, as I'm sure it is for many. I picked my majors, I performed to the best of my abilities, and I was really proud of my performance overall. My years in university are also where I discovered who I was, and envisioned the person I ultimately want to become. I've never allowed myself to take things slow - I've been on a path where things need to get done so that a bigger, better thing can happen. Thankfully, this approached has worked for me so far. I've completed the checklists needed to get me into medical school, so now as second year comes to a close I think to myself, "now what?"

You don't get to medical school, or other professional / graduate programs without being at least a little competitive. Whether it's an outward competitiveness or competing silently with your self, that competitive nature lies somewhere and its influence is undeniable. It pushes you to do better than before, and be better than you think you're capable of. But to get you to push yourself and grow there must be a drive beyond self-fulfillment, and that drive is uncertainty. The future is always uncertain to some degree, and this is what pushes us, at least me, to work harder to at least attempt to secure the future I want. Up until this point in my academic career, worth has been determined by test scores and grades. It's something I'm comfortable with. In two months, however, I take the most important test of my life - USMLE Step 1. An exam of this caliber is something that I'm not familiar with. The implications of my score go beyond a few numbers on a page - it can determine what specialties of medicine I can comfortably apply to. Though there are students who manage to match into competitive specialties with low Step 1 scores, they are the exception and definitely not the rule. Residency applications are all about numbers, this is something our attendings, student development staff, and mentors remind us of often. It is unfortunate that the individual applicant isn't evaluated holistically, but it's a numbers game and there's only one way to play.

The start of medical school is a clean slate where every student has the potential of pursuing whatever specialty they wish. Some of my classmates came into med school knowing exactly what specialty they wanted to pursue, and for many of them their initial interests still hold true. I, however, have a few interests but I'm not certain about any of them. And it is this uncertainty that pushes me into unfamiliar territory, and isn't comfortable. Nevertheless I know I have to do my absolute best on the boards to give myself the best chance. My biggest worry right now is falling in love with a specialty that my score isn't "worthy" of. And therein lies a whole other realm of what it means to feel "good enough," but that's a whole other topic perhaps for another day.

I know that the best approach to the boards is to do my best and not make any excuses. There's no use in worrying now since my efforts should be focused on these last two months of studying. In the end, there's never regret in knowing that you did your best.

  

Happy Thursday everyone! I’ve recently been really into breakfast foods and have been looking to spice things up a bit. My mornings usually consist of walking Melo, followed by a an hour of studying on Firecracker with a hot cup of green tea. After that, I like to do some fasted cardio on my elliptical for an hour or so. That means that by 10 am I’m pretty hungry! Usually I just drink a vanilla hemp protein shake - which i’ll discuss in a future post! - but some days I like to indulge and cook breakfast for myself.

Anyone who knows me personally knows that I love eggs. Seriously, I love eggs for any meal, anytime of the day. I can honestly go through a whole carton of hard-boiled eggs a week - egg whites only, of course. They’re just such a simple, protein-packed snack that is so satisfying and low in calories. So of course I’m going to share a quick, healthy, egg-centered breakfast that I personally love. Enjoy!

Ingredients:

2 eggs*

1 cup chopped spinach

1 cup sliced mushrooms

1 tsp basil

1 tsp pepper

Directions:

1. Using 1 whole egg + the egg whites of the other egg, cook over medium heat until they are “over medium” - or desired consistency

2. In a separate pan, sauté the spinach and mushrooms over medium heat until mushrooms are soft. Add pepper and basil.

3. Serve and enjoy!

*This recipe calls for two eggs, though you will only be using 1 whole egg + the egg whites of the other. You will be discarding the second egg-yolk.

Nutrition Facts:

Calories - 221

Protein - 11.6 grams

Last Friday I had the opportunity of shadowing in the OR. It was with the same peds ortho surgeon as my last post about shadowing in clinic. He was so welcoming and very eager to teach, and the OR was no different. I made sure to ask which cases to prepare for during my clinic day since I wanted to be ready for any questions and to just have an idea of what was going on.

I arrived at the hospital at around 6:45 AM.  I was then escorted to the locker room by the unit clerk. I locked up my belongings and changed into some surgical scrubs. I was excited to see what the day would hold so I wasn’t really tired. Plus I had my compression socks on so you know I was ready for anything. And by anything I mean being on my feet all day. Sidenote: if you don’t have compression socks you should totally invest in them - they keep your feet from hurting after walking all day, and help with circulation which, in turn, helps to prevent varicose veins and edema. Basically compression socks changed my life when I was working 16-hour days on my feet before med school. Now where was I? Oh right, my OR day.

A nurse was waiting for me outside of the locker room, she was our OR nurse for the day. The surgeon hadn’t arrived yet so she asked if I wanted to go see our first patient and have some consent forms signed while we waited to head into the OR. We went to see the first patient and got to chat a bit with the anesthesiologist we would be working with all day.

7:30AM - Our first surgery was a tarsal coalition patient. Although tarsal coalition is a genetically inherited  condition, children do not typically become symptomatic until adolescence. It can be quite painful for patients and results in a stiff, painful foot that limits everyday activities. The surgery only lasted about an hour. It was a quick resection of the coalition which was then replaced with a fat graft. Even in surgery it was apparent that the foot was so much more mobile and flexible than before.

9:45AM - Spondylolisthesis of L4. This is described as a forward or backwards slip of a lower lumbar vertebrae, usually L4, L5 or on the sacrum. This results in an abnormally aligned spine and can be painful. It isn’t that common in peds patients, but our patient had a particularly severe case. The surgery involved a direct repair of the spondylolysis with wire loops and bone grafting from the iliac crest (hip bone). This was the longest surgery of the day at almost 4 hours long. Even though I was wearing a lead gown to protect me from the xrays taken during surgery I was freezing by the end of it (seriously, I was SO cold that my skin was sore at the end of the day from shivering!). I was impressed at the number of people in the room. During the first surgery there was the surgeon, his first assist, a surgical tech, a nurse, an anesthesiologist and myself. During this surgery there were an added 4 people in the room: an EMG tech (who monitors muscle activity), two xray techs, and an ortho hardware “expert.” As if the amount of people in the room wasn’t intense enough, the actual surgical bed was both huge and intricate since the patient had to be strategically placed in a prone position (face down) while allowing access to the spine.

1:15PM - Lunch time. I was starving. We headed to the doctor’s lounge and found all kinds of free, delicious food!

2:00PM - ACL reconstruction. At about 2.5 hours in length, this surgery was my favorite of the day by far. I had no idea that before you actually repair the torn ligament, a graft must be taken first. It can also be from a cadaver, though it isn’t the preferred method. The graft was taken from the patellar tendon and this took about one hour. The ACL reconstruction was then performed through arthroscopy. Inside of the knee is weirdly beautiful - the contours are smooth and pearlescent. It was pretty cool to see. I was impressed at the amount of hardware that goes into an ACL repair. It seems like there's a specific tool for each step, which I suppose is probably common in ortho or any other surgical field.

4:45PM - Before leaving for the day we went to check up on the spine patient and prescribe extra pain medication. We also visited another surgeon's patient on the ward.

5:30PM - Done for the day. Leaving the hospital and into some fresh air outside felt really good.

As med students and future physicians we learn every bit of physiology in the human body, or try to anyway. It is easy to forget that those structures and their functions are real, tangible things that are very different from and infinitely more dynamic than the figures we memorize in our textbooks. To be able to see inside the human body and manipulate it to improve someone’s quality of life is a huge privilege, and an even bigger responsibility. Walking up to the family in the waiting room is another very special experience. No matter what the procedure, a patient's family or loved ones await anxiously for news that the patient is okay and done with surgery. Even if I don’t end up in a surgical field I have an immense appreciation for what surgeons, anesthesiologists, and surgical staff do.

It’s spring break which means I actually have some time to relax even if it’s just for a few days! I’ve been craving brownies for months but J and I have been sticking to a healthier diet which means less grains, or in my case almost no grains, almost no sugar, and dining out less. We feel a lot healthier lately and have a lot more energy! But my craving for brownies is still going strong.

I recently found a few recipes for healthier brownies. I finally decided to try my own version and just see how it goes. I didn’t have any expectations but the results were phenomenal! You would never know these brownies are grain-free, dairy-free and free of processed sugar. They were soft, chewy, fudgy, and surprisingly filling - which means you’re satisfied after just one slice, imagine that! I definitely don’t call myself a “baker,” but these brownies were so easy that this is definitely a recipe I’ll keep making.

Ingredients:

1 10 oz. jar almond butter

1 cup of organic agave nectar

½ cup almond milk

1 tablespoon vanilla extract

2 organic eggs

½ cup of cocoa powder

1½ teaspoon baking soda

½ teaspoon salt

1 cup semi-sweet chocolate chips

Optional: Avocado oil

Directions:

1. Preheat oven to 325°F

2. Combine and blend almond butter, agave nectar, almond milk, vanilla, and eggs in a mixing bowl

4. Blend in cocoa, salt, and baking soda

5. Blend until smooth, it will be thick

6. Fold in chocolate chips - I used a spoon

7. Grease an 8x8 baking pan and pour batter in (I used avocado oil to grease, other oil works, too)

8. Bake for 40 minutes (for a 9x13 pan bake for 30-35 minutes)

Before pulling the pan from oven check to make sure they’re fully cooked by inserting a toothpick or thin knife, it will come out completely clean when ready. Allow the brownies to set until cool before serving.

Enjoy  !

This past week I had my final exam for my second-to-last block of second year. It’s pretty crazy how fast MS2 has gone by. We got the whole week off to study, so I figured why not shadow in clinic on Monday and in the OR on Friday. It probably wasn’t the best idea considering how much studying I had to this week, but I did well on my exam! And someone in our class aka The Cookie Fairy baked cookies for all of us rising MS3s, it was very sweet.

Before this week I had never actually shadowed during med school. I had actually never shadowed at all, which is weird considering I should have an idea of what specialties I’m interested in since I have to schedule third year electives this month. Oops. Last semester a new discussion-based elective in orthopedic surgery became available. I decided to enroll since taking the elective for two semesters would count as fourth-year elective credit and could mean a week or two off during four-year. I had never thought about ortho before the elective but ended up really enjoying it. My husband is a structural engineer, so he talks to me about random structural elements all the time, like loading, shear walls, concrete, you name it. Surprisingly, it helped me understand a few things in the elective. And even more surprising: I actually enjoyed it. This semester we had a session dedicated to pediatric ortho and I loved it. No matter what specialty I go into, I know it has to involve children since they are my favorite patient population by far.

Monday was clinic day. I arrived early in the morning and clinic started promptly at 9. The staff warned me that it was goingto be a busy day with 20 patients total, but having worked in a derm clinic where we saw 80-100 patients a day I was more than ready. The morning started with more chronic issues like scoliosis follow-ups, hip dysplasia, ACL reconstruction, follow-ups, toe walking, in-toeing, and a club-foot follow up. There were also a few ankle pain visits. Apparently pre-teen girls with ankle pain for a peds orthopedic surgeon is equivalent in frequency to adult lower back pain in an adult clinic. I learned that sometimes the ankle pain will not have any obvious deformity on an xray or manual palpation, and will raise the possibility that the child is somatizing (experiencing psychological distress in the form of physical symptoms). My favorite patient of the morning was a 6-week-old with bilateral clubfoot. Not only was he adorable, but the treatment for clubfoot has lifelong impact. The idea of maintaining function and mobility in children is amazing and I wouldn’t mind doing that the rest of my life.

The afternoon was a fracture clinic. A Monday fracture clinic meant that all the patients would have likely broken something over the weekend and presented to an urgent care or the ED first. After entering the room the temporary cast is removed, the fracture site is palpated to corroborate what the xrays look like (if they bring some with them), then new xrays are taken to make sure proper casting as well as analysis of the break itself. This last step is important because children have active growth plates. If the fracture crosses or comes near the growth plate it is called a Salter-Harris fracture. They occur in 35% of skeletal injuries in children, and are of concern because they can result in premature closure and limb shortening and abnormal growth. As opposed to adults, children heal quite fast. Most of the casts we put on would only stay for 3-4 weeks with a complete recovery. Children are so resilient.

The surgeon I shadowed was extremely welcoming and made sure that I was learning. He was open to and encouraged questions. He also did a wonderful job at establishing rapport. After entering each room, he would address the child first and make them feel like they were in charge, which I think the kids really liked. Most just found it silly. The kids would then feel comfortable enough to tell their story of what happened. The stories were pretty entertaining - a child’s perspective is just so animated and innocent. I was surprised at the variety of cases that peds ortho deals with. They treat musculoskeletal deformities and pathologies secondary to a variety of causes, across a wide age range (infants, children, adolescents, young adults).

I really enjoyed my day at the clinic. I appreciated that most of the problems were solvable and even if surgery was a last resort, there were other less-invasive interventions most of the time. I also liked that the treatment given by an orthopedic surgeon is tangible and life-changing for patients and their families.

Stay tuned for the second part of my shadowing experience - my day in the OR.

Hello and welcome to the new home of my blog - mindfulofmedicine.com! With the help of my sister and her husband’s new web design company I was able to get my own domain, which is pretty sweet. I’m looking forward to posting more often with more variety. Look out for a new post about shadowing an orthopedic surgeon on Monday!