MINDFUL OF MEDICINE

Ever since before we started trying to get pregnant I loved to indulge by reading or watching birth stories whenever I could, hoping that one day I would be able to experience some of what I was seeing and reading. I think that the anticipation leading up to labor and delivery is a crazy, exciting thing - even if it is a little scary! During my pregnancy, I'll admit, I was a little worried about how the whole thing would go down. Was I strong enough? How long would I be pushing? Was I prepared physically and mentally? I had so many questions for myself. Not doubt, just curiosity. The last few weeks of pregnancy really dragged on. I had gotten the okay from my psych elective to just stay home (so sweet of them), the nursery was all ready, his clothes were washed and sorted, the camera was charged, I cleaned the house *twice,* and our bags were packed. I was ready. As ready as I thought I needed to be. Some parts of this story may be a little TMI - you’ve been warned.

At my 37 week appointment J and I asked my doctor if we could schedule an induction in the event that we went over 40 weeks. It was partly because of how excited we were to meet Noah and partly because of my anxiety about having a post-term baby after being in the NICU - in retrospect, working in the NICU while pregnant may have freaked me out a little more than I would've liked. Our induction was scheduled for August 25, 2016 at 40 weeks and 1 day. We couldn't wait. And I was sooooo sure we'd go into labor before then. I was wrong :) and soon enough it was the big day.

We woke up at 5 am that day to pray Fajr (the morning prayer before sunrise) and then I frantically called my insurance carrier because I had forgotten (pregnancy brain) to make sure my delivery and possible epidural were covered costs. They were, and I breathed a huge sigh of relief.. And then we waited for the call from the hospital telling us to come in at 630. I was anxious so I ended up calling a little before, lol. The charge nurse told me that L&D had a very busy night and I'd likely get pushed back until the afternoon, which we did. So we went back to sleep. Not really, though. Neither of us slept we kind of just laid there knowing that we should sleep but we were too excited. We didn’t expect to be called until noon, but at 11 am the call came. We were so giddy and excited. On the way to the hospital we stopped at Subway and I had a footlong sub of all the glorious turkey (couldn't eat deli meat during pregnancy!) and veggies I had been craving for months. I ate it in less than 6 minutes. No big deal.

When we got to the hospital we checked in at L&D. J got his daddy name tag and I got my patient bracelets. The last time I had gotten those bracelets was before my surgery 5 years prior at the same hospital. It’s crazy how life changes! Then we were escorted into our room. When I walked in it hit me - this was our room and the place on this Earth where our little man would join us with the help of God. My friend works at L&D and was sweet enough to set us up with wonderful nurses for the day and night shifts. My day nurse came in and introduced herself, she was really sweet and had what my friend called a “hippie vibe” that would go along with my birth plan. What was my birth plan you ask? I’ll tell ya.

For starters I didn't want men in the room for personal and religious reasons. I wanted to be able to move freely during my labor. I also wanted to labor without any pain medication for as long as I could. We also requested that the baby be given to J right after he was delivered so that he could say the adhan (call to prayer) and the first chapter of the Quran into his ear before skin to skin time with me. Our hospital has a strict “golden hour” policy where, so long as mom and baby are healthy, there is uninterrupted skin to skin for an hour before the baby is weighed or anything which is so sweet. My nurse was down to labor with me unmedicated and offered me all the resources she could - yoga ball, hot shower, etc.

We walked around the unit and hung out in the room for a couple hours while my doctor finished up another delivery. The anticipation was still high and got pretty antsy. In the meantime I was hooked up to the tocometer (for contractions) and a monitor to hear the baby’s heart beat. My pitocin was finally started at 2:30 pm. It was game time.

At 2 units of pitocin I was having really, really light contractions. So light that I didn't even known I was contracting. So every 30 minutes my pitocin was increased by 2 units. I walked around the unit and bounced on the yoga ball. At around 4:30 pm my doctor came in to check how far I had dilated. I came into the hospital at aaaalmost 4cm (had been there for a week!) and had only dilated to mayyyybe a 5, lol. I was surprised but still wasn't in a ton of pain. My membranes were ruptured (my doctor broke my water) and I had to lay on the bed for a while so that Noah could be monitored for distress. Let me tell you, contracting while walking, standing or bouncing on a yoga ball is WAY better than contracting while laying in a bed. It started to get real. Not to mention that the actual breaking of my water was also super uncomfortable. But I kept cool, after all how bad could it get?

I continued to labor on but the contractions were getting really strong. Unfortunately for me, they weren't regular - I’d have a big one, then a couple small ones, or sometimes a few would come right after each other (ouch). My doctor wanted to monitor the strength of my contractions more accurately so she inserted an intrauterine pressure catheter (my nurse said sometimes the external monitors don’t work so great on skinnier ladies, which made me feel pretty good even if it was for only a second). Again, the insertion of the IUPC was pretty uncomfortable since any added pressure or stretching on your cervix during labor sucks. My contractions kept getting more painful and I didn’t feel like walking around anymore. So I leaned over during contractions and J helped with putting counter pressure on my lower back which was amazing. Eventually I moved onto the bed and got down on all fours to help with the pain, while J was still pressing on my back. My lower legs went numb from being in that position and I had to switch to standing again. I was getting pretty tired. I remember looking at J and asking - if I get an epidural am I giving up? He sweetly and obviously said no. So I decided that I would request another cervical check to see if I had made any progress - I had been on pit for 5 hours now - and if I was close to complete I would just push through BUT if I hadn’t made much progress I’d request an epidural.

My doctor came in and checked. I was still at a 5, a generous 5.5 cm. My heart sank but I was in so much pain that I knew it was time to let the pit do its job while I got some relief and rest with the epidural. While I waited for the anesthesiologist my nurse offered me a small dose of fentanyl to take the edge off - I felt like I was floating, it was awesome. And then I got to meet my night nurse, who was so sweet and really helped make the rest of our experience so special.

As I sat over the edge of the bed while the anesthesiologist prepped my back to insert the epidural catheter I thought about how many times I had seen this done to other laboring women. I knew what to expect and wasn’t scared. And I honestly barely even felt when the needle went in. By J's face during the whole thing you'd guess he was getting the needle though lol. It was now around 7:30pm and J was starving so he went to get food while I got settled in with my foley catheter, new sheets, etc. About 5 minutes after J left, my nurse was still with me and I started to get super lightheaded. My face and hands started to tingle and I knew my blood pressure was probably bottoming out. I looked at her and told her I didn’t feel very good. She let out a quick - Oooh! BP was 70/40. She gave me a bolus of fluid and called the anesthesiologist. We waiting another 5 minutes and my pressure dropped to 60/38. The CRNA came in and together with my nurse turned me on my other side and gave me another fluid bolus. All the while, Noah’s heart rate remained strongly in the 130’s which was reassuring. By the time J came back my blood pressure had normalized, Noah was still doing great, and I felt much better. It was scary, though. I think knowing exactly what’s happening to your physiologically can be reassuring at times but it can also freak you out more… especially when it’s your job to get a little human here safely.

From 8pm to 12:30 my pit was increased by 2 units every thirty minutes, I was turned every hour and I tried to get some rest in between. My contractions still weren’t exactly regular and I ended up getting a total of 30 units of pit and my doctor was weary of going any higher. My epidural pump started beeping at almost 1am and I called my nurse. She decided to check my cervix then and asked - are you ready to start pushing? It was so unexpected, like this was really happening. It was so exciting. My only request was that I be allowed to put on lipstick and contacts before we started and my nurse though that was pretty funny. The cool thing about my epidural was that it had officially run out about 30 minutes before she said it was time to start pushing and I was able to move my legs and had core control but still couldn’t feel a thing!

My nurse held my right leg and J took the left and I started pushing at 1:12am. I remembered to engage my full core through all those belly pumping breaths I had been practicing for months. And within 10 minutes my nurse decided to call my doctor because we were making good progress. My doctor arrived and we kept pushing. I never realized it would be so hard to bear down and try not to let go of my breath while pushing - my doctor kept saying ‘don’t give up on me now!’ in the sassy way that she does. I kept looking up at J who was very focused on the corner of the room behind me hahah. When my doc asked if I wanted to feel the head I got so excited, he had so much hair! After a total of 15 pushes and 40 minutes, Noah was born at 1:52am on Friday August 26, 2016 at 40 weeks and 2 days.

My doctor was amazed at how big he was - she thought he would be around 6 pounds but he was a whopping 8 lbs 8 oz and 21 inches long! As she pulled him out she asked - where were you hiding him?! I watched as J cut the cord and prayed in his ear and I sobbed. I cried so much. And my nurse was crying too. Noah was placed on my chest and gave me the sweetest little grunts. The nurse and the tech tried to get him to cry but he refused so they took him to the warmer to stimulate him a little. He still didn’t cry but was pink, had great tone and a good grimace. It’s funny, my mom said I never cried after birth either so I figured Noah was just following in my footsteps. When I got him back on my chest it was the most beautiful, perfect time of my entire life. He looked up at me and I finally looked into his black little eyes that I had been dreaming of. It’s crazy. It’s like meeting a stranger that you’ve known forever and has your whole heart. The next two days in the hospital were absolute bliss. J and I must have stared at Noah for a full 48 hours lol. It was the best experience of our lives.

Thanks for letting me share my very own birth story, guys! One thing I will say is that a good birth partner will make a world of difference. Getting to go through this with J was a blessing in itself. From pregnancy to birth he was there for me and it’s something we’ll never forget. He was an amazing birth partner and now he’s an incredible dad. I hope I can get some time to share what I took to the hospital and put together some baby essentials posts for you guys. Thanks for reading!

Happy Father's Day, everyone! Though J is a daddy-to-be (or a baba-to-be as we like to say), I know he'll be the best father in the world and I can't wait till our little guy is here. I can't believe that our baby shower was just a few weeks ago, time has been flying by these days. I wanted to share some pictures from the shower as I felt so loved and special that day!

J and my two best friends worked secretly for months to put together the baby shower of my dreams - I'm so grateful! My day started off with a prenatal massage (a gift from my wonderful mother-in-law) which was amaaaaazing - seriously, they even had a special prenatal massage bed where I got to lay on my belly (if you've ever been pregnant you'll know that this is a luxury since you can't sleep on your belly without feeling like you're squishing your baby and crushing your insides ;). After my massage I could've taken a 6-hour nap from how relaxed I was, but, alas, J wanted me to feel beautiful and had me scheduled to get my hair done - rough life, I know. By the time I arrived home, I was expecting to see the finished product of the baby shower I had been waiting for, but there were still things to be done before guests arrived! It was actually fun to be part of the pre-party decorating frenzy, including a helium tank without enough helium, balloons that wouldn't stick to the walls, and a sad attempt at filling metallic balloons with a bicycle pump. Oh the drama! Nevertheless we managed to get everything in order and the most wonderful baby shower started right on time :)

[caption id="attachment_879" align="aligncenter" width="960"] These balloons refused to stick to the wall so J had to perform some of his engineering magic. I also finally got to try sangria which always looks so tasty but usually has alcohol, boo.[/caption]



 

[caption id="attachment_878" align="aligncenter" width="960"] So many future female doctors in one picture![/caption]

 

[caption id="attachment_876" align="aligncenter" width="6000"] This cake was, hands down, the most delicious cake I've ever had at a party.[/caption]

 











[caption id="attachment_868" align="aligncenter" width="6000"] J got us a copy of Love You Forever, only the saddest book ever :)[/caption]

 

 

I started Family Medicine right before winter break (which was almost 6 months ago, bear with me - I'm trying to catch up on all of these!). After finishing both medicine and peds, family med was a good summary of the two and gave me lots of exposure to a strictly outpatient setting. Interestingly, at our institution the family med attendings and residents have labor & delivery privileges in the hospital for their low-risk Ob patients, though I didn't get to experience that with them it was definitely something I could have participated in. Family med offers a broad range of patients, diseases, and opportunities for intervention. This rotation is where I most actively participated in promoting preventative care strategies which enlightened me to the fact that many patients know very little about the changes they can make to improve their health or that of their families and they genuinely appreciate learning how to do so. I also didn't have to give up my favorite patient population - kids! - because I saw lots of babies and well-child visits. My clerkship site took place in our university family medicine outpatient clinic. It was very academic setting that focused on teaching and featured 4-5 residents (and 1 med student - me!) supervised by 1 attending. There was also a huge integrative medicine influence in the clinic from multiple attending which was neat.

CLERKSHIP OUTLINE:

• 6 weeks of outpatient care + optional labor & delivery experience


• scheduled lectures for 3 days


• NBME shelf exam

CLERKSHIP WORK HOURS:

Because this clerkship was in a strictly outpatient setting, I worked Monday-Friday from about 7:50 to 5:30. I didn't have call or weekend shifts (something I definitely should have appreciated more lol). The days varied in terms of how late I would stay depending on what the last patient of the day needed and if my resident & I got really behind.

A day in the life:

On any given day in the clinic I would wake up at 6am and workout, walk Melo and get ready to leave the house by 7:30 in order to be at clinic by 7:50. Since our clinic is academic there's a 10-minute teaching session by an attending until 8:00am. Usually it was just my best friend and I (I got lucky to be at the same site as her!) since the residents didn't always make it in time lol. But after the presentation I would report to whichever pod my resident was working in and try to prep for patients. Depending on the resident, one of two things would happen 1) I'd see every other patient, or 2) I'd have 3-5 patients assigned to me. I really enjoyed the second option because if one of them didn't show up I had some time to write my notes. Otherwise it was back to back patients with note writing at the end of the day. Most days there was a 40 minute window where no patients were scheduled so that was my lunch time! If you've ever worked in a clinic you know that this window doesn't actually guarantee said amount of precious time so I'd keep checking to see if my patient's had arrived while I ate. After lunch, the flow would be pretty much the same until all the patients were seen.  At the end of the day I would make sure all of my notes were thorough, complete, and had citations / links to current journal articles and research to support my assessment & plans - again, very academic.

In terms of patient care, I'll try to break down what I did for different kinds of patients. In general, I would briefly discuss each patient with the resident before going in. If it was a new patient, I knew I would have to cover your basic H&P details as well as determine whether preventative care screenings were due (colonoscopy, pap smears, AAA screenings, etc). If it was a follow-up, the visit was much simpler and we could address the status of ongoing issues and maybe discuss a couple new ones if time permitted. For prenatal visits, I would measure fundal heights, listen to fetal heart tones and see if the patients were experiencing contractions, loss of fluids, bleeding, fetal movement, and other pertinent symptoms. My favorite visits were the well-child checks. For these, I would discuss key developmental milestones for age and discuss things like nutrition, sleep, exercises when appropriate.

Memorable moments:

• One of my first patients, a young obese boy around age 13, asked us if we thought he was overweight once his parents left the room. When we showed him where his BMI fell along the curve he very maturely asked us to help him with strategies to get healthier. When we welcomed the parents back into the room, we all discussed barriers to health in their home - mainly their diet and lack of exercise. It was pretty cool to approach such a devastating disease like obesity at a young age and with family support.


• On residency interview days we got to meet residency candidates and have lunch with them, which usually featured a delicious tamale feast. It was nice to catch a glimpse at what residency interviews would be like since they're coming up soon!


• Our clinic worked with a very large African and Asian refugee population which helped me appreciate the obstacles that these patients have to get access to care and other life challenges they face.


• I listened to fetal heart tones on a patient for the first time during my family med rotation and it was so exciting - and who knew that J & I would get pregnant that same month. So crazy.

Study resources:

I personally found this clerkship hard to find good resources for. This makes sense because the testable material for this specialty is so broad and covers internal medicine, pediatrics, gynecology, obstetrics, geriatrics. preventative medicine, and psychiatry - to name a few. Because it covers so much, this shelf can be really challenging if it's taken at the beginning of third year. So taking it after 12 weeks of internal medicine and 6 weeks of peds was probably the best prep I did for it and I would highly recommend scheduling it at the middle or end of your third year if possible. To begin my studies,  I went back into my pediatrics and medicine UWorld questions and brushed up on my previously incorrect answers. I also reviewed the medicine and peds shelf reviews by Emma Ramahi - can't say enough good things about these! I signed up for the AAFP question bank but found that there were too many questions and that the level of difficulty was more at a resident level and wouldn't be helpful for the shelf, so I didn't use them. I went through Pre-Test as well, but didn't feel like I learned anything new. Rather, it was a decent review - though I'd only suggest doing this if you have enough time. Otherwise, I made sure I knew the US Preventative Task Force Guidelines for as many things as possible, mainly hypertension, diabetes, women's health, children's health, smokers, etc. The good news is you will end up learning most of the guidelines and management of primary care diseases organically during your work in the family med rotation.

Advice:

During my family medicine rotation I met some of the genuinely nicest people to work with. The residents truly cared about their patients and their passion for primary care was really admirable. It's easy to be inspired when those around you make an effort to improve the health of their patients in such a sincere way. So one way to be successful on this clerkship is to be present and actively participate in the care of your patients - you learn so much by simply doing your part!

Hello!

This time last year I was totally immersed in my Step 1 studying, as I know may of you second years out there are - don't worry you'll get through it :). I wanted to write a blog post about how to make a UWorld journal since I've gotten a few questions on it recently. I feel that it was so critical in my success on Step 1 that I want to share it with others. In my research before starting my own I gathered that a good "journal" needed to have a few key components. These are: 1) the main question or concept, 2) key facts that help you understand that concept, 3) any figures or images that will help you remember or learn it.

Because UWorld doesn't allow you to copy & paste, you must be selective about what to include in your journal. Theoretically you could make an entry for each question, but that would take a ton of time - time you frankly don't have! So make sure to only make an entry for questions that surprised you, taught you something, or you know you won't remember. If you know a concept trust yourself and move forward. Successful Step 1 studying is as much about organization / efficiency as it is about knowledge. This is your time to put the skills that make you an expert learner to the test. It's also a good thing that UWorld doesn't let you to just copy content because it forces you to put things into your own words and flow. Also, when it comes to images or tables in a UWorld explanation, you'll have to create the tables on your own and hand draw any figures you find helpful - just one more strategy to commit concepts to memory.

When I studied for Step 1, I created tests that were single-subject. For example, if I was getting through the cardiovascular section, I would create a test of just the anatomy and finish those questions before moving on. I've continued this trend while studying for shelf exams while using the Step 2 UWorld Qbank. It's been a great resource to be able to review my shelf UWorld journals before each exam.

Here's an example of a few journal entries during the Medicine section in UWorld, specifically the GI questions:

For simplicity and efficiency I use Google Docs for all of my UWorld journals, and organize them by topics. That way I don't take up space on my computer AND I can access them wherever I am on my iPad or phone. I know some student like other programs like Evernote, etc so do whatever works best for you! When it comes to figures, I like to have blank sheets of paper on hand as well as my fine tip markers to draw them out. I actually learn so much by drawing them out myself especially because it helps me visualize the actual figure later when I have a question on it.

I hope this post helps with clearing up what exactly a UWorld journal is, though the details will vary from person to person. Remember that this is a tool and if you find yourself spending so much time on it that it keeps you from learning efficiently, it's okay to try other things. If it works for you that's fantastic too :)

Good luck studying!

Hello!

From the moment we got pregnant I had a feeling we were having a boy. But then, at our 12 week ultrasound, the so-called "angle of the dangle" (aka the angle at which the genital tubercle sits in relation to the spine) suggested that the baby was most likely a girl. So we got used to the idea of having a baby girl on the way. A part of me felt like my instincts were off but I went along with it. After all, a healthy baby is all that really matters!

Two weeks ago J and I went through arguably the most exciting part of pregnancy - finding out the sex of the baby! As soon as the ultrasound tech placed the probe on my belly I saw a little penis, lol. Having seen my share of anatomy scans during my obgyn rotation I knew exactly what I was looking at and it was clearly a little boy! I kept quiet, and gave the tech a chance to share the news with J and I. We were overwhelmed with happiness! It also meant that my initial intuition was spot on :P.

We're so excited to bring a little boy into this world and hope to be the best parents we can possibly be! Here's a glimpse of our little one.

[caption id="attachment_833" align="alignnone" width="364"] For all my Muslim sisters out there, please say mashaAllah <3[/caption]

 

19 weeks (I know, super late - but Melo makes up for it right? :P)

Hi guys!

If you've been following along you know that I'm pregnant - 20 weeks today to be exact! We go in for the anatomy scan tomorrow and we're hoping for a healthy baby, plus we'll finally get to find out the sex which is the most exciting part. Now that I'm five months into my pregnancy I've had a lot of time to reflect on how we got here. I wanted to share our pregnancy journey since the moment we started planning but decided to hold off until it happened for us. The two biggest parts of our pregnancy journey have been planning for a baby during medical school and getting pregnant. Since I get a ton of questions about planning for a baby in med school, we'll start with that!

Planning. Ever since I started med school I've heard the phrase "there's never a good time to have a baby" as a woman in medicine. I think that's true, but there are certainly better times than others. Besides, is there ever a perfectly convenient time to bring a little life into this world? Probably not. The first step in planning for a baby in medical school for us was to commit to our decision to pursue such a goal. J and I have always wanted to be parents so finding a time wasn't just a task it was an exciting adventure to embark on.  In terms of financial planning, J is an engineer who is still early on in his career so finding a time to have a baby also depended on our financial situation and making sure that we could comfortably afford to provide all the things a baby might need. I also had to meet with my financial aid office to discuss funding (in the form of student loans) for all potential childcare and baby expenses. We're definitely not the first to have a baby in med school so the financial aid office was really helpful in giving us a game plan on how to get enough money for our potential baby.

My health was another barrier to our baby plans. If you know my story you know that I had a long battle with coccidioidomycosis, also known as Valley Fever, for which i was on high doses of anti-fungals for about five and a half years. As far as my ID doctor was concerned I would never be able to come off the meds and that inevitably meant that pregnancy was contraindicated (at the risk of craniofacial and congenital heart defects). There was even more worry that my cocci would disseminate if I were to become pregnant and discontinue my meds. Luckily I'm really involved in cocci research and I convinced my ID doctor to talk with attendings from my research group and go over my case. With their blessing we decided to start a trial of no medications 1 year ago and thank God (alhamdulillah) my antibody levels are stable and I feel great. The only catch? I have to see my ID doc every month to make sure I'm doing okay and get blood work just as often.

And finally, how do you fit a baby into a medical school timeline? This was such a huge question for J and I. There's no guide that can tell you when to have a baby in med school. That's because there are so many factors that go into it including finances, your partner's career, specialty choice, research, childcare, and how a baby would interfere with courses / rotations and overall graduation date. I feel very lucky to have seen a couple of my friends have babies in med school because their advice was so helpful. One friend had a baby at the end of MS1, which was good for her since she had a full summer without any school responsibilities. But that also made taking step 1 and starting clerkships the next summer more challenging with a toddler. Another friend had her daughter after match, which was convenient in that she had a difficult pregnancy and was able to take care of herself during a relatively relaxed fourth year. However, she started intern year with a three-month old which had it's drawbacks as you can imagine. I admire my friends and their ability to tackle motherhood early in their medical careers but it wasn't easy for them. And this left me even more confused about whether there is ever a good time to have a baby in med school. And the truth is there isn't; you really have to find your own path and make it work for you. Taking a year off for research / to have a baby was never in our plans so that was ruled out from the beginning. Eventually, J and I decided to aim for a due date during the first few months of fourth year (July - September).. That way I could complete my 1-month sub-I and another 4 week rotation before going into labor. This timing was also important because residency applications are due in early September and residency interviews start in middle to late October. This timing meant that I would be pregnant during the last half of third year, which included physically demanding rotations like obgyn, general surgery, and trauma surgery. Though being pregnant during those tough clerkships would be challenging, we thought it was worth it - and I can now happily say that I made it through! This timeline was the best approach for us, and it's important to remember that you have to do what works for you and your partner! A plan is a valuable component of having a baby in med school, but what about actually making a baby?

Getting pregnant. So you're ready to have a baby, now what? Being a meticulous person (J included!), my plan for getting pregnant was also calculated. I'll start with the changes I made before delving into the emotional aspects of the journey.

I had started tracking my cycles a year before we started trying so that I could get "in tune" with my body. I also made diet changes like cutting out caffeine (I love green tea) and purchasing more organic vegetables (see foods you do and don't have to buy organic). I also started to exercise more and tried to be smarter about my workouts - incorporating both cardio and strength training. In particular, I started doing something called "belly pumping" to establish core strength before pregnancy which I found on instagram @thebloommethod (check them out!). Side note, you can belly pump during rounds or in surgery and no one knows you're exercising but you, lol. In terms of ovulation tracking I used a free cycle app, ovulation test strips and my own symptoms. My symptoms were pretty in line with my app so that became our main resource. I didn't really like the ovulation strips because they're so subjective in their reads and often the quality varies between strips.

After a few months of trying I could feel myself getting stressed and even sad about each month that passed without seeing those two pink lines on a positive test. I'm usually a very rational, mellow person but trying to bring a little life into the world and feeling as if it's not going to happen is on a completely different emotional level than I've ever experienced. Many couples try for so many years to have a child and my heart truly goes out to them. Once I noticed that J and I were both starting to fatigue and worrying that perhaps it wasn't meant to be, we changed our approach. We only had two cycles of "trying" left before we would have to stop and wait to try to have a post-match baby or even until after intern year. It was high stakes, but I'm proud of how we handled it. We had been praying to have a baby, but now we prayed that we would have the strength to leave it up to God entirely.

In December 2015 J and I sincerely believed that if it was meant to be it would happened and if not, it wouldn't. And we were absolutely at peace with that. We stopped stressing. One of my attendings recommended a book she had read when she was trying to get pregnant called Be Fruitful by Victoria Maizes, MD - one of the integrative medicine gurus in our academic community. I needed some clarity and honestly wanted to know if maybe I had missed something and could be doing something better. What I found in the book (which I highly recommend!) was helpful on multiple levels. Among the many lessons I learned from the book, a few of my favorites are:

- it's okay to pray for yourself.

- Come off of birth control with enough time to get to know your body, its cycles and your symptoms at all points in your cycle.

- Make your body a suitable vessel to grow life through diet, mindfulness and lifestyle.

Later that month, I finished up my Family Medicine shelf exam and we traveled to Calgary for a family vacation. On December 22, I missed my period and figured it was just a fluke haha. But then I realized I hadn't been late for over a year. I knew something was up, but I wasn't fully convinced. I asked my sister in law to bring me a pregnancy test so that I could find out and possibly surprise J. And to my sincere surprise, two little pink lines showed up - I had finally gotten my "big fat positive" as the internet pregnancy forums like to say! I wanted to cry but also felt a little dizzy, lol. I called J upstairs. He looked very confused and silently walked out to the car and we drove to buy not one but 3 more tests! They were all positive and J teared up. Then we went out the next morning and we bought one more, just to be safe. It felt so surreal! It wasn't until 8 weeks later that we got to see our little bean on one of my obgyn night shifts when my chief kindly performed an ultrasound that J got to come see. Seeing that little heartbeat was so special.

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I hope this post helps those planning for a baby in med school because I know how hard it can be to find a good time. I also know that making a baby isn't always easy and there may be a lot of challenges along the way. If I could give one piece of advice it would be to just relax. Seriously. Stress only makes things harder and we're all stressed enough already! Enjoy the journey, it's among the most noble of all. Also please feel free to email me if you'd like to talk about your own journey, I'll do my best to help!

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The dean addressed my class last year. Being MS2's on the verge of Step 1 and clerkships, I know that we were all anxiously awaiting our big leap into third year, away from the daily grind of lectures & exams - that felt like a more intense extension of undergrad. I know I definitely was.

Our dean was very sincere and wanted us to remember that while medicine is absolutely a calling, it is also a job. A job that we will have to go to, make a living from, and often spend more time at than we do at home. This struck me as a surprise, though it shouldn't have - my husband has been telling me this for years. Still, I refused to believe it. After all, my personal statement it its meticulously crafted wording, imagery and passion did not have room for the possibility that medicine could be reduced to a "job."

As third year has slowly marched past its half-way point, the pressure to commit to a speciality is very real. For some, third year confirmed their interests and solidified their career goals. For most, however (myself included), it has been a year of soul searching. While the hours we work as third years are usually less than the residents, it's the most time many of us have worked in our lives. On top of spending hours at the hospital or clinic, we still study and balance families - a huge transition from the lecture-based schedules of our past. It is also the first time we have become active participants in the care of our patients. The experience is life changing; no amount of research or shadowing can give you a better perspective into a specialty than third year, which is limited to begin with.

I've heard of third year students becoming "jaded," but now I like to think I have a little more insight into the issue. In my experience, we retain our passion for helping people, improving their lives through medical care, and genuinely care about the well-being of our patients. But something definitely changes and that's the sudden realization that we will have to factor in our priorities (family, personal time, hobbies, etc) into our lifelong career. And that's where the the big questions arise: what field of medicine will make those brutal years of residency worth being away from the things and people we love? What will I be happy doing many years from now?

I've been reading Dr. Paul Kalanithi's memoir "When Breath Becomes Air" (which is just absolutely wonderful by the way). In it he mentions that he watched as:

"one by one, many of my classmates elected to specialize in less demanding areas (radiology or dermatology, for example) and applied for their residencies...by the end of medical school, most students tended to focus on 'lifestyle' specialties - those with more humane hours, higher salaries, and lower pressures - the idealism of their med school application essays tempered or lost."

This paragraph struck me. The latter part of it putting into words some of the emotions I had been battling through. I went into medicine because it is my calling and I never saw myself doing anything else. I had experiences that solidified my passion, and some that even cost me my own health but also clarified what kind of doctor I wanted to be. In my med school personal statement I promised to approach the care I provide holistically, with humanism at its core. That hasn't changed. But I would be lying if I said I have not grown and changed in the years since starting med school. I've become more of an adult in med school, not only because I've hit the mid-20's mark but also because I have a clearer vision of what I want in life and how I want to make an impact. I've learned that placing your work above yourself and your family is detrimental and, frankly, unsustainable. So certainly, at some point your interests must come before your patient's when it comes to being able to take care of yourself. How can we provide the best care when we ourselves are far from whole? Medicine is a calling, but doctors are also human.

We are not only searching for the field of medicine we enjoy the most but also making an attempt at predicting what we will still get out of bed for in 30 or 40 years, when our bodies have inevitably lost their youthful vigor; when our priorities have changed and we simply see life differently.  As one of my attendings so eloquently put it, "as humans, we are tragically bad at predicting what will truly bring us happiness." And when it comes to choosing a specialty, the stakes are pretty high. Some people may choose to switch specialities mid-residency, but for most of us that's not an option when years of education, student debt, and anticipation are relieved by the light at the end of the tunnel that is completing residency and being a bonafide doctor.

For all of these reasons and many more, choosing a specialty is hard. I feel very privileged to be in a position where I've earned the right to make this decision but it is a big one indeed.

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I am really interested to hear what other med student's thought's are on the subject, so please leave a comment below!

 

Hi everyone!

If you follow me on Instagram you probably already know the big news - I'm pregnant! This is such an exciting time for us and I can't wait to share pregnancy related posts with you, starting with our pregnancy journey and first trimester survival tips. This is also the reason I've been a little quiet on the blog - first trimester can be rough - but I'm hoping to change that!

I just finished the first three weeks of my surgery rotation on a busy general surgery service, which needless to say were tough even for someone who isn't pregnant! This weekend I'm relaxing and battling a cold, gotta love pregnancy-induced immunocompromise. But, I start trauma surgery on Monday - that's right, 28-hour shifts every three days so any prayers and good vibes are much appreciated.

Down below are more photos from our announcement photoshoot and, of course, an image from our 12-week ultrasound <3

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Last week I had orientation for obgyn (obstetrics & gynecology) as well as several days of lectures from attendings and fellows on a broad range of topics. They were all fascinating but one stood out in particular: gynecologic oncology. We discussed the pathophysiology, treatment and patient counseling involved in uterine, ovarian and cervical cancers. While discussing ovarian cancer, we came across the topic of ways that patients cope and how they become involved in their own care. The one thing that really resonated with me was when the gynecologic oncologist commented that many of her patients, after their diagnosis, have a new-found passion for their lifestyle and general approach to wellness - often indulging in the newest cleansing trend, trying alkaline diets, etc. This really got me thinking - why do we wait so long, often after we've been dealt a bleak outlook, to change or do something about our health? Procrastination is arguably human nature, but shouldn't we be more proactive about health? One would think so, but that's not always the case.

Since it is January, I know we've all seen the social media pictures poking fun at the fact that gyms are all of a sudden teaming with new attendees. That's not to say that this isn't a real thing that happens every year after people have formed their new years resolutions à la "new year, new me." To me, this makes me reflect on two big points: waiting too long to change, and discouraging others from making a healthy change.

As a soon to be physician and someone who is passionate about my health and that of my loved ones, I consider myself an ambassador of health. This is a role I hope to embody throughout my career. I am not perfect, and though I've always striven to live a healthy life, I have certainly had my own struggles with optimizing my nutrition and lifestyle. This was especially true during my toughest years of my battle with Valley Fever. For example, during those years I would fluctuate between 100% commitment to avoiding gluten, dairy and any excess sugars while trying to keep my liver healthy; and sometimes I would indulge and inevitably feel guilty and resentful. I was lost in a vicious cycle that caused me a lot of grief when I really should have focused on eating clean, whole foods and staying active.

In our world, we're constantly bombarded with messages that immediate satisfaction is the key to happiness. These marketing strategies exploit our collective social tendency toward ignorance of one simple fact: short-term satisfaction does not build long-term change. But we have to be better than that, and not wait until it's literally too late to make a change. That means preventing disease before it happens, and one of the greatest tools we have is ourselves, equipped with both a mind & body. Through proper nutrition and lifestyle we can prevent, cure, and manage disease and that's very powerful, at least to me.

One other idea I've been thinking about is why we discourage others from making a healthy change, whether unintentionally or deliberately. I often see fitness trends marketed as exclusive movements that require some kind of acceptance into the larger group. This takes me back to those pictures I mentioned before, while they might make us giggle they are actually alienating many people who are genuinely trying to make a change but might feel like they're not welcome. The truth is, we all start somewhere. And the purest place we start is from within. That's why it's so important to encourage others in even the smallest of ways without being proud or aggressive and showing them that you truly care. No matter where someone is in their health & wellness journey, you can help encourage and motivate them. That might mean starting at the ground floor, like encouraging someone you care about to stop smoking; to applauding a friend's long-term commitment to exercise & even joining them.

I know this sounds like a bit of a soapbox but it's something I'm really passionate about. It's 2016, and even though we have incredibly advanced medical technologies and sophisticated treatments some of the most potent therapies we have are on our plates & our physical activity levels. We can all make a change, and we don't have to wait until it's too late.