FINALLY......SURGERY!

Last night I had my first overnight trauma call. I worked with my team (colorectal surgery) from 5:30 am to 6 pm and then switched to trauma surgery. It was exhausting and exhilarating and scary all at the same time. I honestly didn’t feel much fatigue for most of the night. Our bodies are capable of so much more than we imagine; especially when something important is on the line. Granted, “I’m just a student.” But even a student matters when all hands have a role. Being on surgery for the first two weeks has been an interesting experience. I LOVE surgery. I fell in love the moment I stepped in the OR at Texas Heart Institute my first day in summer 2005. There’s a high and adrenaline rush that you can’t explain. But there’s something more, there’s something in me that SHOUTS this is why you’re here and honestly I am almost brought to tears by the reality of that discovery. It’s such a gift to have an idea of what you are called to, even if only for a season. As I started my rotation last week I was listening to the voices around me. The voices that say………you’ll work 80 hours plus, you’ll never sleep, you won’t be able to maintain relationships, forget about exercise or eating healthy, bedside manner will go to the wayside and on and on. And my first week was HARD. I was tired; I was overwhelmed by new expectations and new attending physicians. Would I make a good impression?? Would they see what I feel inside? I’m not the best at tying knots. My sutures leave room for improvement to say the least. But God gave me a real peace about all these tormenting thoughts running through my head. I don’t have to be perfect in my first week of formal surgery rotation. In fact, I don’t have to be perfect when I’m a 30 year veteran surgeon. It’s impossible. But what I can do is my best. And God has given me the strength and the stamina to work these hours and stay enthusiastic. I’ve been able to keep my optimism and put a smile on my face. Dad always says “Lord in your heart….smile on your face.” And that is the truth. I’ve always heard that in order to serve and love others you have to look to God to fill you up first. If He is your source then you can’t run dry. And God is revealing that to me RIGHT NOW, RIGHT HERE. I am humbled and grateful. And eager to get back to work tomorrow……but now it’s time for a much needed nap :) Love you all.

Halfway.....

First, feeling much much better. Thanks friends. So glad to be out of pain and able to eat again!

I'm halfway through my internal medicine in Jacksonville! I got to come home for my day off, and it felt so good to sleep in my own bed! Ate sushi and saw a movie last night, watched football, and more today! I'm enjoying seeing friends and taking a break from the hospital. To say I am forcing myself through this rotation would be an understatement. Basically if the only option in medicine was internal medicine, I would not be a doctor. But it's teaching me to rely on God more to make it through the day to day. I'm really trying to remember my patients need a friendly face as motivation to keep my spirits up.

But my free time in Jacksonville has been much more enjoyable this time around! One of my closest friends from high school just moved to Jax with her husband, and we've had dinner a couple times. Last week I watched the Glee premiere with my resident from the Children's Hospital and a friend from home. Not to mention eating out as frequently as possible with my classmates :) AND I got my hair chopped off on Friday! It's a reverse bob with highlights. I'll put up pictures ASAP---just trying to avoid the picture in the mirror look. So far, I love it!

Hope you all enjoy your Sunday!

Role Reversal

I am beginning to believe empathy is hard to embody unless you have truly experienced a patient’s adventure in the medical system. Nothing compares to the feeling of helplessness, vulnerability and insecurity. On Friday night I spent 10 hours in the local ER. I had delayed going for treatment for hours. I went through the differential in my head. I hypothesized tests and treatments. I couldn’t think of anything unique the ER could do for me. Finally the pain was too substantial and a friend drove me to the hospital.

First lesson: never write “abdominal pain” as your chief complaint. This is too vague and NOT treated as emergent.

I was one of the last patients to be called and that was with connections on the inside. When I finally made it to my corner with a curtain, I could immediately tell my physician was not impressed. I actually suspected the first morphine injection to be a saline injection to test me. It was only after several more doses of morphine and residual pain that the physician began to take me seriously.

Second lesson: when a patient asks for more morphine, seriously consider giving them more morphine. It’s not as strong as you think.

Throughout my ten hours in the ER, the physician NEVER discussed a plan with me. I did not know what he was thinking or what he was testing. I was lying in a cold ER in a thin gown. I was in pain, and I was confused. I can only imagine how my patients must feel.

Third lesson: explain in as much detail as possible your plan of action. Do not draw blood without explaining why. Do not use multiple US probes in various places without explaining yourself. A patient’s body should be treated as a temple. Do not violate that temple without at least addressing them.

After several hours, still writhing in pain, I was wheeled to CT. My technician was kind and comforting. He brought me a warm blanket and explained each step to me. We actually had a decent conversation. The test went by quickly and he brought me back to the ER. After another 4 mg of morphine I finally started to doze. As soon as I fell asleep, my ER physician woke me up abruptly and started telling me his assessment and that I would be sent home. I could hardly follow him, and I actually UNDERSTAND medical terminology. I was trying to keep my eyes wide open and hear what he said. In the end, I heard………possibly early appendicitis….you may need to come back….take these pain pills……could be a colonic spasm……maybe gastroenteritis…..ok bye. He quickly rushed back out of the room. Now, I know he is busy. There were several people in the ER. But I just needed five minutes to understand. I’m still not sure exactly what we accomplished in the ER. I’m glad I went but only because I can’t imagine how much pan I would have been in without 12 mg of morphine.

Final Lesson: Do not rudely awaken patients and give them a two minute summary of their problem. If you do, come back once they’ve had a chance to digest and answer questions. Do not assume they understand even if they are familiar with the medical field.

Although ultimately it was a horrid experience, I am glad that I have a new found appreciation for what my patients will experience themselves. I hope that I will be able to maintain empathy even when I am busy and overwhelmed.

Back to Jax.......

A long overdue photo from our night at the Sublime Cover Concert which was a lot of fun!

The last few weeks have gone by so quickly! I officially finished my pediatrics rotation on Friday. Tomorrow morning we have orientation for Internal Medicine; then Tuesday morning I'll drive to Jacksonville where I'll be living for the next four weeks. I'm going to work at Shands-Jax for the first half of this rotation. Downside: We work 6 days a week. Upside: I'll be back in the hospital (vs clinic) which I prefer Also, Jax is overall more relaxed than Gainesville.

Spent my free weekend relaxing with friends and playing trivia. I also went to see 500 days of summer. It's an awesome movie. It's a very realistic look at relationships. I'm still a cynic but who knows what the future holds....

I think a found a church home in Gainesville! I went with a friend to First Pres. downtown, and I really enjoy the teaching and fellowship. Everyone has gone out of their way to welcome me. I already feel at home. I think I'm going to join a small group when I finish in Jax. I have been struggling with finding fellow Christians who seem authentic and NOT legalistic, so this has been a refreshing change. I also have accepted that no church will be like Calvary in Waco.

In other random news, watched the funeral for Senator Kennedy yesterday. Amazing service. I was very moved. I may not agree with all his policies but what an influential man.

Ok. That's all i can think of for now. Paulo Coelho has a new book! I'll let you know what I think ASAP.

Update!

First week of outpatient pediatrics is DONE! I must admit, I am very glad. I do not think clinic will be my calling in life. We have to herd patients through as quickly as possible just to keep up. If we don't go quickly we won't be able to see everyone. This is VERY unsettling for me. I like to be thorough, and I like to have more time to have a conversation with my patients. I've also realized that unfortunately our society is still divided. Many of the lower socioeconomic status families, particularly African Amercian, are very distrustful of me. Since I'm only a student, I understand. Truthfully, how can I TRULY relate to their situation? I live a life of privilege and opportunity. I don’t know what it means to run out of money before I buy the groceries or to be unable to buy over-the-counter Tylenol for my children when they have a fever. But I am doing my best to remain open and love these families the best I can.

Outside of clinic, it’s been WONDERFUL to be back in Gainesville. I have been able to catch up with friends and get back to an exercise routine. We celebrated Laura’s birthday last weekend (pictures above), and tonight we’re going to a Sublime cover show. Kristen and I went shopping today for new outfits. I’ll have to post pictures later. This afternoon we also watched Body of Lies---great movie. Definitely recommend it. I started playing water polo again but it looks like I’ll have to quit for good unfortunately. I keep reinjuring my hand and can’t afford to risk my future career as a surgeon. It breaks my heart 

Enjoy the photos! More to come soon!

jumbled.....

Gone are the days of hanging out with musicians until 4 in the morning. Going to concerts twice a week is no longer feasible. Even Reggae Tuesday is going to take a hit. So what happens next? Is this "growing-up"? Am I confined to a life of boring nights, collapsing into bed and then waking up before the sun? I don't really mind the decrease in free time, what I do mind is the lack of adventure in the free time I have. I miss adventure. I need distraction. And I don't want my free time to involve medicine. This is a very frustrating transition. I LOVE work; I couldn't be happier. This is what I was made to do. BUT, working 24/7 is unhealthy. And I need an escape.......

Sleepy.....

Another busy week at the Children's Hospital! From what I can tell, we're busier than usual for July. Luckily, my team is great under pressure. Everyone stays patient and friendly despite the work load and lack of sleep. I was exhausted this week but drank a few extra coke zeroes and pressed on. Mom was thrilled to know I stopped dropping weight (5 pounds in the first two weeks unintentionally) and I attribute that to my now daily brownie intake :) I'm anxious to get back to Gainesville and my usual schedule. I miss sushi, working out, and my FRIENDS. I came back this weekend for a day of rest. It's been so nice to sleep in my own bed. Tomorrow I'm on call back in Jax so I'll leave early tomorrow morning.

My biggest struggle this week was anxiety over my patients. The simple truth is that I am not in control. I've never been good with that in any situation. So I'm learning what it means to leave it alone. Unfortunately, the control freak in me is fighting back. I need to trust that when I leave at the end of the day I'm leaving my patients in good hands and even more important, in God's hands. Please pray for me as I tease that out in the next several months.

This will be my last week at the Children's Hospital. I have several assignments due but it should be a fun week regardless. I think my team is going out for dinner or drinks at some point. I'll miss working with them. Hope you all have a lovely week! I can't believe August is upon us already!

What Makes My Heart Sing......

There were MULTIPLE occasions during my first two years of medical school that I questioned my career choice. Medicine is a business, it’s political, the patients can be rude, they often don’t take responsibility for their own health, etc. But when I left the hospital this Friday, all I could think was that my heart is FULL. I can’t imagine being more fulfilled and happier in any other job. I worked 14 hours on Friday; my feet were aching; my head was pounding; and all I could think was I LOVE THIS. Yes we lose patients and that is and will always be a tragedy, but we help a lot of people. And let’s just be honest, working with kids all day is pretty fun. This week I played an arcade game with one patient, watched the Disney Channel with another, and heard about one boy’s dream to play football for the Florida Gators and Jacksonville Jaguars. We have the unique privilege of entering into people’s lives. And sometimes they aren’t the most compliant or kind, but it’s still really cool.

At Calvary Baptist Church in Waco they ask every new member what makes their heart sing. I always pondered exactly what I would say…..but now I know.

Excited for the week ahead!!

A Dose of Perspective

Working in healthcare will certainly adjust your perspective. In the hospital, everything matters. One lab result can change the course of treatment. Each choice influences the path of illness for that patient. Every staff member from the tech to the surgeon has to be on top of their game at all times. What we do has a profound impact. That kind of responsibility is humbling and frankly quite scary. But I’m most surprised to find that it’s quite exhilarating at the same time. Of course right now, as a student, my contribution is minimal, but as a whole, my team is really making a difference. We are saving lives and even if the disease is not life-threatening, we are still an intricate part of that person’s health. Pediatrics is interesting because an entire family is usually involved. The parents want to be there, so the other siblings are usually there. Even grandparents come to help. Illness is truly affecting the whole household. And what we do as healthcare providers is affecting that entire household as well, hopefully for the better. No we’re not perfect, so it’s not always the ideal interaction. But we still keep trying.

Now here’s where I’m stuck today. When everything at work means so much, carries so much weight, how do you come home and face the more trivial things in life? How do I continue to be patient and sensitive to others even when their concerns seem trivial compared to work? And this doesn’t just apply to others, it applies to me. What does it matter if my shower is lukewarm instead of hot, or that my dorm room is cold and bare? It’s not the end of the world if I don’t work out EVERY day and eat a perfectly healthy diet. But at the same time, those parts of life are necessary. If I lived under the constant pressure of the hospital, all day, every day and never left, I’d burn out. There has to be a time for the trivial. So I guess I’ll just have to keep working this one out. No answers yet.

Day 1

As I listened to his heart, I thought to myself, “good, no murmurs…I’m still not sure how to describe those anyway….” What I didn’t ponder was the possibility that in less than 24 hours this heart would no longer beat. A heart that previously fueled a person who was active and outgoing…..a heart that was loved and loved in return family and friends….What do you do when the unexpected happens? When tragedy strikes? What do you do when the wind is literally knocked out of you with the death of a previously healthy child? On my very first day of my very clinical rotation, I was assigned a patient. At first, I only knew his hypothesized diagnosis. I researched the disease until I could meet the patient. Then I met the family. Concerned, respectful, open and helpful. The very fact that they would allow a medical student to come in and ask them 1,000 questions that they’ve already been asked MULTIPLE times is significant. But the fact that they welcomed me into their lives at the most vulnerable moment possible is humbling. And then I met my patient. In obvious pain but compliant, I examined him to the best of my ability. Throughout the day I stopped by and served as a ‘gopher’ for answers to questions and basic necessities. I was happy to fulfill this role; one of the only things I feel confident doing at this point. I stopped by to say goodnight at the end of the long day, and told them I would be back bright and early in the morning. Only the morning was not quite so bright. Overnight, my patient quickly deteriorated and could not be saved. Stunned….and a bit unsure I asked what had happened. No one was quite sure but everything had been done. I was assigned new patients and the day continued. Although all the staff were visibly distraught over the situation, there was work to be done and other children to serve. And yet I felt the pressing need to reflect, process, and yes, pray. We had a brief moment in the day so I went to visit the family (who had not left the hospital). My heart pounded as I proceeded to the room. What do you say???? Do I give them a hug???? My heart was literally broken in two over a group of people who had been strangers only two days ago. Certainly God intertwines all things. Was it chance that this was my assignment? I don’t think so. The day before I had heard the mom offer a plea for prayer to a friend. At the time, I knew my professional role was to remain detached in the religious arena. So I didn’t tell the parents, but I began my own prayers. Today as I stepped through the room, I decided professionalism or not, now is the time to be a fellow believer in Christ. As I knelt by the mother, I told her although it may not make things better, I wanted her to know that myself, and my family had been and would continue to pray. I think the nurse heard me. She wasn’t thrilled I was there in the first place. Overall, I felt at a loss for words. I’m still not sure what else I could have said. I think I might try and find a chaplain in the hospital and ask how they interact with the families in these situations. Certainly, the scientific and medical approach I’ve been taught feels less than adequate.

I had two new patients today. One has already left the hospital; the other although ill will not face any significant damage in the long run. Tomorrow I’ll be given new patients and meet new families. I’ll walk by the same room my patient died in last night and there will be new children in his place. Last night I read Jesus’s parable about the talents. When I went to work today, I was determined to invest the five talents I’ve been given (intelligence, people skills, etc) and reap five in return. And although I don’t know much yet and I can’t help much medically, I am determined to give my all. So tomorrow and each day I’m going to consider the burden and responsibility a healer carries. And praise the Healer who is ultimately in control.

Please pray for all the families in our hospital facing loss today, but especially for my patient’s family.

Nicaragua

I have so much to share; I don’t even know where to start! Nicaragua has been on my heart since the moment we landed back in the States last year. It was truly surreal to return to the country. This year’s trip was different from my experience last year but still an incredible opportunity. We set up a clinic in a rural community outside Masachapa, Nicaragua. Like last year, the local pastors of Nicaragua assisted with registration and then sent them to our stations. We had adult clinic, pediatrics, ob-gyn, surgery, pharmacy, optometry, and dentistry. I helped organize the medical students (14 total!) so that we each had a chance to work in the stations. We had enough physicians to work one-on-one with the students! They were so eager to teach us. I think I learned more in one week than in months of med school. We had two surgeons with us this week too! Dr. Pittman let me assist him in multiple surgeries! I’m slowly getting better at suturing. I also really enjoyed working in pharmacy and optometry even though those are areas I’m less interested in pursuing.

I didn’t journal as much this year but here’s an entry from mid-week:
This afternoon I worked with Dr. Spencer, a cardiologist. A woman came to our clinic with past echocardiogram results that suggested she had asymmetric cardiac hypertrophy. Hypertrophy is usually due to hypertension so we took vitals but she was fine. Dr. Spencer started looking at her medical results and discovered a simple miscalculation. We had an ultrasound machine so he used it to examine her heart. Her heart was healthy and normal. Once we explained this to our patient, the tears started rolling down her face. She was so relieved. It was an awesome moment. We came here aiming to cure and treat, but today we gave someone peace and hope. That is priceless.

Overall, the trip this year was less of an emotional high. Perhaps not quite the “mountain-top” experience I had last year. BUT, I learned a little about what it means to serve because you feel called, not because it makes you feel good. A lot has been going on in the last month in my life and the lives of my friends and family. To say that I felt drained and broken would be an understatement. I desperately prayed that God would “fix” me before Nicaragua. I didn’t think I could serve or be joyful unless I was whole first. But that’s not Biblical. God continually uses broken people. And He reminded me that He can use me and help me grow no matter where I am in my walk. I still wouldn’t say I’m completely healed but I will proclaim that God is faithful and sovereign. He was glorified in Nicaragua, and I pray that He will continue to be glorified through seeds that were planted last week!

Thank you to everyone who supported me financially and through prayer! You made this trip a reality, and I’m so grateful for the opportunity!

Enjoy the slide show!

Nicaragua 2009

Make a Smilebox slideshow

Oh, oh We're halfway there.....Oh, livin' on a prayer!

On Monday, Feb. 23, I took my LAST pathology exam! It was no doubt the hardest class we've had thus far. From what I've heard, it's downhill from here!

Tonight, the pathology department and our hard earned loan money put on FUNGUS BALL 2009! Dorky name....FUN TIME! Kristen, my roommate, was my beautiful date for the evening! It was so nice to dress up and relax with friends after SEVEN months of hard work!

Enjoy the pics!

Zach Deputy

I almost forgot! After sushi last night we went to hear Zach Deputy perform at Common Grounds. While some of the lyrics were not our favorite, this guy has SERIOUS MUSICAL TALENT. He was amazing! And all the tracks I've heard online could not compare! Check him out on youtube! You know I love the steel drum :)

http://www.youtube.com/watch?v=cPzwkhVc39Y

Adventures with Alligators and an Octopus......

As many of you know, I am OBSESSED with sushi! I have had sushi nearly daily for almost two weeks. Not many things have been palatable this year so I usually give in to my ridiculous cravings :) Last night I went to Dragonfly with some friends and we had amazing sashimi! Eating sushi is fun; eating sushi with friends is FABULOUS.

Now it's time for you to meet OCHO the baby Octopus. He was a sweet octopus...always listened to his mother....took out the trash. But his time had come.

I ate him. The end.

Today Laura and I went to Lake Wauberg. I can't believe I've never been before! Laura is kayaking with her mom tomorrow so we went to practice. I distinctly remember rolling my eyes at the lifeguard when she told us to stay in the kayak.....of COURSE that would not be an issue.........

Midway in the lake Laura tells me there are alligators in the lake. ALLIGATORS. WHAT?!?!?!? Oh well, we're safe in the middle of the lake, nice and dry in our kayak....Five minutes later, we're in the water and wondering how that happened. MINI PANIC ATTACK....THE KAYAK WON'T FLIP OVER.......I'M GOING TO LOSE A LIMB.......ok we're back in the kayak. Safe.....whew. Five minutes later.......this water is cold. Why am I back in the water??????? Once, twice....FIVE times we tipped our kayak. Once my heart slowed down and I realized it wasn't actually my time to die (unlike poor Ocho) I could not stop laughing! What a fun adventure!!! It felt so good to relax and be outside in the sun! Thank you Laura!!!!!

Thoughts for the day......

Our oncology professor, Dr. Lynch, recently shared his experience with both joy and sorrow in the field of medicine. A classmate mentioned this work and I thought I'd share. I would definitely recommend reading the entire piece; it's thought provoking.

An excerpt from The Prophet by Gibran

Joy and Sorrow

Then a woman said, "Speak to us of Joy and Sorrow."

And he answered:

Your joy is your sorrow unmasked.

And the selfsame well from which your laughter rises was oftentimes filled with your tears.

And how else can it be?

The deeper that sorrow carves into your being, the more joy you can contain.

Is not the cup that hold your wine the very cup that was burned in the potter's oven?

And is not the lute that soothes your spirit, the very wood that was hollowed with knives?

When you are joyous, look deep into your heart and you shall find it is only that which has given you sorrow that is giving you joy.

When you are sorrowful look again in your heart, and you shall see that in truth you are weeping for that which has been your delight.

Some of you say, "Joy is greater than sorrow," and others say, "Nay, sorrow is the greater."

But I say unto you, they are inseparable.

Together they come, and when one sits alone with you at your board, remember that the other is asleep upon your bed.

Verily you are suspended like scales between your sorrow and your joy.

Only when you are empty are you at standstill and balanced.

When the treasure-keeper lifts you to weigh his gold and his silver, needs must your joy or your sorrow rise or fall.

NATIONAL CHAMPS!!!

A year later and so much left to learn.....

As I contemplated Ash Wednesday today I was reminded how important it is to take a few minutes and reflect. Thus, after much time away, here I am mulling my thoughts over in my head. And what you may ask is inside this brain tonight??

We leave in less than two weeks for Nicaragua. This has been my passion since the moment I stepped off the plane last year. God has been so faithful to provide for our team. This year we're taking 10 students and raised over $15,000 in the process. I wasn't even sure that was possible. And to think I would doubt our amazing God. But this process has not been all sunshine and butterflies. Little did I realize what "leading" a team requires....the organization, the motivation for everyone, and A LOT of patience. What a bittersweet pill it has been. At times I wanted to throw this burden off my shoulders and run in the opposite direction. I could be on a cruise for spring break. I could be with my family. And then I remember that if I just lay it at His altar, it won't be a burden anymore. And so today I found myself again pulling my hair out over insurance and more FORMS and yet I still rejoice. God is going to change me, change us, change the people we encounter. And for that I am grateful. In that I am humbled.

Second year of med school is almost over. Never have I felt so unintelligent and yet never so knowledgeable. So many facts in so little time. But I must admit, I knew none of this 18 mo ago and that's progress. This week we're trying on white coats which will then be embroidered with our names. Never have I been so proud. As Dad and I joke, this will be my day in white. And I do believe I will beam as if a bride. What a journey it takes to reach this point. And what an adventure it will be to learn how to live in relationship with those who are suffering and those who are healing. Truly there is something spiritual in that interaction. After months of book work, it's hard to look past the science. Harder than when I started. But I pray that I will not loose the ability to connect with someone on a deeper level. Desensitization is my enemy.

Eve is almost done with her first year of college. Unbelievable. I am so proud of her. The year has brought challenges and yet she faced them head on without backing down. She inspires me.

This year has brought many new friends including a group of music producers who now entertain us constantly. It is a breath of fresh air to hang out with friends outside of school. Through these guys we've made lots of new friends who seem to have a knack for relaxation and perspective. I am eternally grateful for that peace. They have also introduced me to a love for reggae music! I can still hear Eve and Mom laughing at Dad and I as we danced to the reggae music in the restaurant. The radio can get old so quickly. Live reggae is personal and fun. In fact we're hoping to go to a concert tomorrow night!

I am sure there is much more to say. But I think I will call it a night. Sleep has become a precious jewel this year. May each of you find God in a personal way this Lenten season. I continue to pray that I will discover God for who He is and not who we've defined Him as. For surely God is not in the box of legalism or unbending religious views; I will find Him in the sullen face down the hallway and the laugh of a classmate. This Lent, I am striving to know the Christ who walked through Jerusalem so many years ago proclaiming a message that will not be easy or convenient but will surely end in joy.

with hope,
K