Inspiration.

“Inspiration is hard to come by. You have to take it where you find it.”

– Bob Dylan

I am thinking about Inspiration today.

I don’t necessarily agree with Mr. Dylan on the first part of that quote. When I need it, when I’m looking for it, and when I’m open it to it, I find Inspiration everywhere. I posted the quote because of the second part, because Inspiration might not come in the form you expect, and you have to be able to recognize it, appreciate it, and take advantage of it when it does arise.

Like this comic by The Oatmeal:

TheBlerch

I was randomly searching for something, anything funny to cheer my brother up this week on The Oatmeal’s site (a frequent source of material for cheering my brother and myself up, as though we share basically no phenotypical qualities, we do share the deeper, genotypical (?) highly twisted sense of humor for which The Oatmeal regularly provides perfect fodder) when I came across an ad on the site for “I believe in THE BLERCH” t-shirts.

Hrmmm…..what could The Blerch be? I wondered.

Which led to me reading the comic, and BAM, the Inspiration. Which I have been looking for, for months now, to start exercising again. Not that I am some sort of Awesome Regular Exercise Type Person. But I do like to do something that at least resembles exercise on a regular basis because it makes me feel better and I get kind of (ok, more) squirrely if I don’t.

And because some jackhole stole my (actually chained up for once, tyvm) bike early this year, that has more often not than not, been in the form of jogging. (Jogging very, very slowly mind you, but still – completely objectively – faster than a walk. So will give myself enough cred to call it “jogging,” but not going to go all crazy and call it “running.” Sorry….just had to take a little break, and actually laugh at that. No, not running. Not even close.)

All of this actually (getting to the point here, promise) led to me going on said jog today. After which I finally felt much less like this guy…….

TheBlerch2

And more like this chick…….

WW

Please note, I actually, in reality, look nothing like her. But for approximately 2 minutes after that 30 minute jog today, I did kind of feel a little Wonder Woman-ish. And it was awesome. (Take that sedentary lifestyle! Pew pew! And that, scary call shifts! A Pew, pew, pew! Who likes endorphins?! I do! Pew!) Thanks Oatmeal!

Also, as I’ve said before, I’m frequently inspired by music. I have listened to this song……

Pretty much every morning the last 2+ weeks while hauling my sorry behind out of bed, and getting ready for another work-a-day, and it never fails to get me going. (I just listened to it again, Yep, still awesome.)

And lastly, I have been inspired to keep writing and posting more consistently by evidence that someone is actually reading, looking at my pictures, and would like to see more.

So, no saved uncropped version of the original Corn Dog Pic unfortunately Marcus, but maybe this one will do?

Corn Dogs Take 2. Mmmmmm.......

Corn Dogs Take 2. Mmmmmm…….

(And thanks for the Inspiration! :D)

QOD

I have been totally lax on posting QOD’s.

Not that there has been any lack of them considering that I work in Gynecology, and I speak to my brother (i.e. Best Source Of Quotables Ever, who I highly suspect will/should have a sitcom some day based entirely on sh*t he has said, ala Sh*t My Dad Says) at least once a week.

So, here a few recents I haven’t been able to get out of my head (no matter how hard I try):

“Just take the hair off where you’re going to put the patches. You’re not manscaping anyone here people.”

“If they have a nitro patch on, take it off and throw it away. If they have a fentanyl patch on, take it off, and put it on (demonstrates slapping patch securely onto left bicep). This is a stressful situation.”

– ACLS Instructor. Much like flight attendants, I enjoy an ACLS instructor with a sense of humor. And anyone who can maneuver the word “manscaping” into a conversation.

********************

“Just say “I came here to deliver babies and chew bubblegum. And I’m all out of bubblegum.””

– Words of encouragement from my brother. Told you.

********************

Virtually anything from Text From Dog. Witness:

********************

And lastly,

My kind of optimism.

QOD

Me: “And be sure to come back in if your symptoms continue or get any worse.”

Patient : “Oh, don’t worry about that doc. Suffering, is not my bag.”

~ (One totally groovy) LOL

Yet another reason why I love OB/GYN. Working with pregnant ladies and LOL’s.

Because Little Old Ladies, are Awesome.

QOD

“There are two tragedies in life. One is not to get your heart’s desire. The other is to get it.”

~ George Bernard Shaw, “Man and Superman” (1903), act 4

Right. Well, the night before Match Day, despite my best intentions and precautions, I totally freaked out.  And when all the crying and blubbering finally (mostly) stopped, I had to drink a glass of wine and take two benedryl before I fell asleep. Which I did at ohhhhhh, roughly 4 am.

I completely slept through the surgery I’d wanted to go to, and upon realizing this, when The Writer finally, gingerly, roused me approximately 40 minutes before I was supposed to be at the Match Ceremony, I totally freaked out again. I felt horrible about missing the surgery. Probably, completely unnecessarily because my presence was in no way required, no one probably expected me to show up for it, and they probably wondered why h*ll I would want to be there in the first place on Match Day.

I still felt horrible for missing it.

I related all of this to The Professor as I sped home, crying, to get ready for the Match Ceremony. They told me to calm down and get some coffee. Always good advice. I stopped crying long enough to order coffee. When it came, desecrated with the gobs of whipped cream I always, explicitly, opt out of and didn’t have time to get rid of, more crying. (Every freaking time. McDonald’s, You Suck. You and your d*mn ubiquitous whipped cream.)

I dumped the despoiled coffee, took a deep breath and coughed. (I heard Jon Tesh say on the radio once that coughing can stop the impulse to cry. Not that I ever, actually tune into the JT radio show on purpose. I actually think he sounds like an overly-cheerful, borderline pompous, dinghus. I’m sure he’s actually a great guy. Whatever. I was desperate, and it seems to sort of work.) I speed showered, threw on some (relatively) unwrinkled clean clothes, smeared concealer on the raccoon rings under my eyes, and went to face the Match Music.

I think (hope) that I participated and behaved acceptably enough for the Powers That Be. (Even without the sweaty, pastel, OB/GYN-only scrubs I had highly anticipated donning as erstwhile armor against the inevitable.) I don’t remember much of it. I went up and got my envelope, opened it in front of everyone when told to do so (instead of in private as I had been counting on and hoping for), and went up to the front of the room and announced the results when it was my turn.

I did not cry. Thank you Auto-Pilot.

I made menial conversation with the people who stopped by my table and the one med student friend who was also alone and took pity on my aloneness (and probably obvious underlying freakedoutness) and sat with me. (I really appreciate that they sat by me. Thank You med student friend). I tried to eat something. I obediently lined up and smiled for obligatory Match Day pictures.

Which will probably end up looking less like this....

And more like this. I tried ok.

I slipped out as soon as I thought I had put in an acceptable amount of time of acceptable behavior for the Powers That Be.

I drove around doing errands. I thought about the QOD above, which I’d read earlier in the week on another med-blog. It was a powerful post, which has since been deleted (and I totally understand why), on the things we give up or compromise on in life, in the pursuit of dreams. In the pursuit of an MD.

I got my first choice in The Match, my heart’s desire. It is, possibly, probably the most amazing career opportunity I have ever had in my life. The culmination of, and reward for, years of hard of work and sacrifice. It is also the realization of my deepest fears. A Massive Move to a faraway, completely unfamiliar Big Scary City, A Million Little Pieces of Detail, and worst of all, leaving my loved ones and possibly (probably?) my last, best chance at a family behind.

The finality and irrevocability of it hit me. There is no going back after The Match.

I did not cry. I tried to remember how much I love the work, how badly I want to make the world a better place, and how much this amazing opportunity is going to help me do that. I dialed my shink to schedule an appointment, turned on Mickey & The Motorcars, and kept driving.

QOD

“So, do you actually, like, deliver the babies or whatever?”

“Well yeah. Sometimes.”

“But….why????”

“Uh, because it’s awesome. Why not?!”

“Because….you’re pulling out this…..this….six to eight pound…..Ball of Liability that no other doctors want to touch!”

~ Exchange between myself (assuming you can guess my part) and another (health professions, but non-med student) student earlier this week. (Also, the best “Why the F would you want to do OB/GYN?” quote to date. “Ball of Liability,” just slays me.)

It’s been kind of a rough week. First of all, I’ve been studying my butt off to keep up with my current rotation. By 2 am Wednesday (yesterday? was that really only yesterday?) I was struggling to make myself get through another 68-page NCCN guideline by rounds at 0700, wondering how in the h*ll I’d managed all the (unrelenting, almost 24/7) studying the first two years of med school. And I still have no idea. (Seriously, how????)

And then, of course, it is Match Week. At this point, I am acutely stressed/borderline freaking out about it, and frankly, this is how I would prefer to spend it:

Hiding. And pretending like nothing is happening.

Versus, apparently, Everyone Else In The World:

Everyone Else In The World. Ready to PAR-TAY.

My less-than-enthused attitude about the general party vibe/actual Match Party was unfortunately noted by the Powers That Be which led to:

Major Butt Chewing In The Middle Of Rounds + Gross Sleep Deprivation + Already Moderate Steady State Of Stress → Uncontrollable Tears of Mortification/Anger (aka The Worst) + Ignominious Dismissal From Said Rounds = Current Acute Stress Level With Increasing Chance Of Five-Alarm Freak Out

Now I understand, and am completely cool with Everyone Else In The World chomping at the bit to tear one off the instant they tear open that envelope. More power to ya. I, however, am more consumed with all the implications of The Match, and see that missive as more of a (n almost literal?) Pandora’s Box, rather than an invite to the Kegger Of The Century.

I have no idea where I’ve matched. It could be any of the programs I ranked. Part of me is excited to start the next phase of my career, mostly because I will finally just be doing (hopefully) all OB/GYN, all the time. But right now, the larger part knows that no matter where I match, it means I will be leaving the place I’ve lived for the past decade-plus, and with it, the people I love, behind. I will be going somewhere urban, which will be a huge change from the sleepy little (I’m talking little, like pop. 306. On a good day.) communities and way of life I’ve grown accustomed to, where instead of knowing everyone, I won’t know a single soul. And in the meantime, I will have a Massive Move and a Million Little Pieces of Detail to contend with. Including remembering how to lock my doors again, and learning How Not To Get Mugged.

I wish I was different, but this is how it is, and this is what I am going to see when I open that envelope. I don’t know how I’m going to make myself do it (honestly, preferably after a suitably large dose of Dutch Courage), but I sure as h*ll don’t want to do it in front of a bunch of people I haven’t exactly been BFF’s with the last two years.

As a last resort, I made an appointment with my shrink and asked them what they thought I should do. They advised me to hit up one of my attendings for some benzodiazepines.

I am not even kidding.

........Um.....no (???). And P.S. That is why I pay you $150/hr. So, I *don't* have to resort to such measures.

Right.

Instead, I decided to go to my Happy Place, aka L&D. (Reason #476 Why I Know I Have Chosen The Right Specialty – When Life gets me down, I go to Work to cheer up.) As often as possible, every time I had a chance this week. I got in on several deliveries and even got to catch and suture once. (Hence the QOD.) It was so wonderful. Brief islands of blissful engagement to the exclusion of all else, where I focused solely on the patients and the work, and basked in the eventual joys of multiple birthdays.

Sigh.

I’m going to a Gyn surgery first thing in the morning. One last sweet reprieve before I will be forced to face The Match Music. I still have no idea how I am going to get through it. Just that (somehow) I will, and I that am going to be wearing my sweaty, pastel, Just For The OB/GYN’s scrubs when I do.

(Not-So-Youthful) Enthusiasm

Today, is just, a great day.

It is a beautiful, uncharacteristically snow-free, somewhat Spring-y March day outside, I’ve officially got one less week before I’m done, I get to spend (another!) entire weekend off with one of my most dearly beloved best of buds, plus, I learned SO much this week!

SO much.

My excitement about all this learning of Useful Stuff (with all due sincerity) cannot be overstated.

Other Student on Rotation: “Um, yeah, I’ve never seen someone get this excited about RPhWorld. I applaud your, uh, enthusiasm.”

Me [madly, gleefully clicking links]: “Are you kidding me? This is so….I mean it’s just….so…..awesome!”

~ One of many, new-found knowledge Moments Of Joy courtesy of this week.

Sure, I have been tired out, adjusting to spending so much time just reading and studying after months of purely clinical experiences, but it has been so worth it. I have been tearing through ACOG Practice Bulletins and Cecil Textbook of Medicine and learning ridiculous amounts of clinically useful information.

For instance, did you know:

* That Primary Hyperparathyroidism is the most common cause of hypercalcemia and Glucocorticoids are an extremely effective treatment for hypercalcemia but only in conditions where hypervitaminosis D is the underlying cause?? Or that hypercalcemia can lead to depositions of calcium in soft tissues (including the cornea!) especially when there is concurrent hyperphosphatemia??

* Or that albuterol (in higher than usual doses) is a treatment for hyperkalemia? And calcium gluconate used to treat hyperkalemia is actually used to counteract effects of high levels of potassium on the myocardium??

* That standard of care is to discontinue antenatal chronic B/P medications within two days of finding out a patient is pregnant, then you should offer an alternative medication (usually methyldopa), then you need to discontinue methyldopa within two days of birth and resume the antenatal medication?? Unless its an ARB, ACE Inhibitor, diuretic, or amlodipine, which are all contraindicated with breastfeeding??

* That 70-85% of pregnant women have nausea and vomiting, and 35% of those women have clinically significant nausea and vomiting (leading to significant psychosocial morbidity), and one study found hyperemesis gravidarum is undertreated and has lead patients to terminate pregnancies??* That Vitamin B6 and doxylamine (Unisom) are first line treatments for nausea and vomiting in pregnancy, and that preconception supplementation with a multivitamin can potentially help patients avoid or diminish nausea and vomiting in pregnancy?? Not to mention, that if not treated with Vitamin B1 (Thiamine), pregnant women who have had significant nausea and vomiting for > 3 weeks are at risk for Wernicke’s encephalopathy with lasting neurological sequelae?? (I mean, what??)

* Don’t even get me started on everything I just learned about OB analgesia and anesthesia. Seriously.

Pretty much my life for the last week. So frigging awesome. Really.

Ah, unless you are watching me study. Which, apparently, is so frigging boring.

Oh! And, in addition to the usual clinical resource suspects (i.e. UptoDate), I have been discovering and plundering new, amazing, and (very importantly!) reliable provider and patient** resources. Such as:

RPhWorld.com – Ridiculous amounts of pharmacologic knowledge. And calculators. I had no idea so many helpful med/clinical calculators existed in the world (For the Maths impaired individual, this has to be on par with finding oil in your backyard. RPhWorld where have you been all of my medical life?) AND it is FREE. No. Joke.

ACOG.org – Chock-full of everything you ever wanted to know about OB/GYN and more. For providers and patients. (Note: Plus, as a student you can apply for membership for FREE. Pssst – ACOG membership looks really good on a CV if you are going into OB/GYN!)

Epocrates Online – This is a standard resource for clinicians, particularly in the form of smart phone apps, but I also discovered providers and patients can register online (again, for FREE) to access not only tons of information about medications, but also about common disease conditions. (Note for students: If you click on a disease and see the resources listed below, you can often click on a citation for a full text article – Bonus!)

Medscape – Another standard resource, but note it is also for providers and patients. Plus it is another (reliable) source of the latest news in medicine, full-text articles, and again, you can use it for FREE if you register.

This is just a taste of the clinically relevant bounty I’ve encountered this week. I could keep going (like, indefinitely), but it’s time to pack for a weekend of extreme fun (in which I continue suppression of all obsession related to The Impending Match. With loads of BFF QT. Yay!).

Such, a great day. I daresay if L&D picks up next week and I actually get in on a delivery or section in the midst of another week’s learn-a-thon, life, will be all Mary Poppins and sh*t.***

*According to ACOG and an NEJM article.

**Personally, I have been encountering quite a few patients lately who are getting medical information from TV commercials (“I’m not taking [Insert Medication Here]!! Have you heard all the side effects of that [Insert Medication Here] on the commercial??! Hell, my [Insert Body Part here, usually, Pecker] could fall off!!” Usually, I have seen the commercials, and can’t say I blame them.), Woman’s Weekly, or Dr. Google. I am all about providing patients with quality educational materials, and I think it is totally awesome when patients take the initiative to research medical conditions and treatments, so I love having actually accurate, and reliable, sources to refer them to.

***Practically Perfect In Every Way

QOD

“When he sticks his finger up my @ss, I’ll prove I should be the star of Our Town!”

~ Mike Birbiglia, “There’s something in my bladder”

I was hunched over the steering wheel at 6 am this morning driving to the hospital, peering through the two square inches of windshield I’d grudgingly scraped, and cursing the endless winter (snow is cute and all at first, but when it lasts this long, I just get angry)  when I heard Birbigs on the radio. I’m pretty sure it’s the first time I’ve ever laughed before my first cup of coffee and/or 10 am.

Make that very sure.

I started a nice, new, more “flexible” rotation today. [Note: “Flexible” in 4th year roughly translates to “Time For Naps.”] On this rotation, we spend time rounding and are then left to our own devices to study a chosen learning issue to present the next day.

Naturally, since I’m new to this, instead of The Mature Choice (i.e. studying Learning Issue right after rounds), I chose to nap. [Note: Don’t judge. I’ve almost finished four years of med school while continuing to work most weekends as a nurse. I am really tired. Plus, I had an awesome dream where I was totally rocking at karaoke, which is absolutely only feasible in a dream. Totally worth it.]

Which means, I have to spend all night studying and not blogging so I don’t look like a total ding dong tomorrow. I may have Senioritis, but not bad enough that I don’t care about looking like ding dong. Plus, it’s kind of fun to actually have protected study time again. [Note: I can’t believe it, but it’s true. I like learning. Mostly just about medical stuff. And random historical stuff and art. But not The Maths. Never The Maths. Explains a lot.]

Hahahahahahaahahaa....No seriously, I have no idea why this is funny.

That's more like it.

Anyway.

On my way to the study cave I listened to this week’s podcast from The Moth. Surprise! It was Birbigs again. Telling a story about being a patient. The only thing better than Birbigs just riffing is Birbigs riffing on health care……..

Get the rest of the story at The Moth. And while you’re at it just subscribe to their podcast. So good. For reals.

And now I’m going to study. For reals.