Starting Gyn Rotation and Reflection on a Failed Date

I finished my month of Ob and now am starting my month of GYN in my two month OB/GYN rotation at Oakwood hospital. It look like this month is going to be much MUCH easier to schedule than the previous month. Most of it is elective surgery. The biggest issue with OB is that women give birth around the clock – there always has to be a team on site. GYN is all surgeries, and can therefore be elective for the most part. I have to do emergency call once a week, where if a woman comes into the ER with an emergent gynecologic issue we help her. Because of the new lighter schedule, I reached out to a few people. I set up to meet my friend SB tomorrow, who I haven’t seen in a while and who I guess broke up with her boyfriend. I really haven’t kept in touch and it’ll be nice to see how she is. I also set up to meet with CS, who I dated for a while in the beginning of the year. Well, “dated” isn’t really the right term. She was dating multiple people and she decided to be exclusive with some other guy. She’s really complicated and thrives on ambiguity. When I told her my feelings she said that she was sorry that I felt that way about her as she didn’t feel that way about me. I’ve been avoiding her for the last few months because I figured “Why bother with someone who isn’t really attracted to you?” However, she is a really fun person and I always had a good time with her. I figured, why not meet up with her? I haven’t seen her in months. We could at least catch up.

I had a date with a cute thin little blonde engineer last Sunday (yesterday…but it feels longer ago). I took her to a brunch place in Royal Oak called Cafe Muse. Neither of us had ever been there before. She was pretty nervous, so I tried to calm her down. However, nervousness is contagious, I became a bit nervous as a result. Normally silences occur rather naturally in conversations. As neurotic as I might come of in this blog, I’m actually pretty good at dates and conversation. But the general vibe that comes from a good date never developed. We were two people who weren’t completely comfortable with the other. I tried to make jokes and they didn’t quite land with her. She wasn’t really into movies, or books, or music. She really liked her job, and her family, and her dog. I covered the brunch and we walked to a bakery where she bought me a cookie. We then walked around town in a cloud of uncomfortable silence occasionally broken by a joke, observation, or question. I stopped by my car, offered her a ride to hers, she declined, then we hugged and I left. If I could redo it, I would walk her to her car and have her drive me back and maybe go in for a kiss. I’ve never had a second date from a kissless first date, but this one was a bit more doomed and an attempted kiss would have been inappropriate. Whatever, I’ll probably never see her again. I told my Dad that it didn’t click and he was surprised with the idea of people “not clicking” with other people. He said that he clicked with 99% of people. I didn’t say anything then, but his definition of clicking is probably just different than mine. You can click at a professional or acquaintance level much easier than on a romantic one and I think he simply conflates the two.

Last week of OB

This was the last week of OB, then I start GYN next week. So many things happened this last week that I made notes to add to this. The week was filled with deliveries. I actually caught two babies, by which I mean that I stood and guided the baby out, held it, and handed it off to be cleaned. For two brief moments I held the youngest person on earth.

I had a date with the 34 year old psychologist. I need a better way to name in this blog, otherwise it marginalizes people. To simplify her down to just a 34 year old woman is a bit drastic. I guess I could still use initials, but it’s a bit…alienating. Regardless, I’ll tell about it.

I set it meet her after I was done at the hospital on Tuesday night in a bar in Dearborn. Because it was two-dollar-beer Tuesday, it was packed. She showed up a bit late, I was reading a book. I think we hit it off really well. Some people just vibe with you. I have a theory that I’ve noticed is that if a girl is way into baseball, we won’t hit it off at all. I seem to vibe more with girls in medicine, psychology, and literary girls. Anyways, she told me how she grew up in Western Michigan, went to undergrad in Ann Arbor, got a phD in Illinois, and worked in Baltimore. She’s lived a very academic and interesting life. I leaned in, listened, and shot the shit. It was a very fun night. I kissed her outside the bar on the way to the car. She’s out this weekend, but we set up to meet next weekend. I’m still keeping my options open though. I’m going to meet with a blonde engineer tomorrow for lunch.

OB Nights

This week I did nights in Ob/Gyn. The hours were 6pm-7am. At first I was able to stay up the whole night, but at the end of the week, I realized that I wasn’t really needed and wasn’t learning anything, so I took 3 hour naps from 3-6 am. I saw more deliveries and took more histories and physicals. Notable things I saw was a 9lb10oz baby born with an episiotomy. I really enjoyed these patients, they were very interesting to talk with. The woman was in nursing and the husband was in engineering. She and her friend were Colombian and were about the same gestational age coincidentally. It was a very pleasant experience.

The major issue that I have with any surgery, Cesarian included, is that it takes so long. I get bored. Surgeries would be so much more interesting if instead of an hour it took 5 minutes. It just drags on and on. After the delivery they have to sew layer after layer back. I stood there holding the retractor, or cauderizing, or maybe throwing a stitch, but I was generally bored the entire time.

Over the course of the week, I got better at secluding myself and reading. I had a pretty productive week academically, however, that’s not really the focus of rotations. I probably should have been more social – mingled more with the nurses, asked more questions to the residents and the like, but in the end, why bother? I just need to get this under my belt and move on.

I have yet to meet with the 34 year old psychologist, but I worked much more on my okcupid profile and it seems to be working substantially better. I got rid of that one picture and fixed the self-summary into something more colorful. I put a timer on and, in real time, just wrote and corrected what I wrote. I had to remove the app from my phone, it’s too addictive. I got a number off of it. She was in Detroit today when I was, but she was at the tiger’s game and I was at Motor City Brewery. I learned last time not to put too much stock into these apps and premature relationships. They all can be fickle and fall apart very quickly. However, it is pretty fun at this point, so why not do it?

My sleeping hours are all mixed up now. I should get to sleep soon and try to correct it all for next week, when I have to wake to be in Dearborn at 7 am.

July 12 – 1 full week of OB/GYN

I have so much stuff I want to put into this post. I wrote short notes over the course of the week that I wanted to expand when the weekend came. Now there’s enough notes to write multiple posts. I’ll just put the prompts and expand them a little.

“Hurry Up and Wait”: First thing notable about this week is that every day started with morning report at 7 am at Oakwood. This entails a 45 minute drive, therefore I had to be up at 5ish every day. I showered quickly and rushed to the hospital. The morning report is mostly irrelevant to med students: we don’t gain anything by going, but we get negatively judged if we don’t. So we rush there, wait around an hour, then split up the patient list between the group. I’ll typically have 1 or 2 patients to whom I introduce myself in the morning and check in with every hour or so. The first stage of labor is the passive phase and can take hours. Once the cervix dilates to 4 cm active labor begins and the baby should be delivered within a few hours. 10 cm and the baby is moving though the birth canal. Once the baby’s head crowns out of the vagina the baby will be out in a few minutes. The process is interesting, but for me, I just end up camping outside the patient’s room with a study book for the day. Hurry up and wait.

Twins on u/s: On Tuesday I went to the ultrasound clinic. In retrospect I think I wasn’t scheduled for it and I “crashed the clinic.” I ended up following techs and nurses around and seeing how they perform ultrasounds on expectant mothers. There was one notable case. I should be prudent in describing it, as it is a real life case and I don’t want to risk any sort of identification of the mother. She had triplets: one fetus by itself, and two conjoined. The conjoined twins were fused side-to-side. They shared one diaphragm and one heart. Each one had it’s own stomach. She was fully aware of her condition and was very optimistic. She said she believed in God and had no intention of aborting. This struck me as kind of sad…she’s putting the unfused twin at increased risk by keeping the fused ones. They are guaranteed to have very short lives. They’re unsalvageable. They only have one heart! But it’s her children and I hope it works out for the best.

C-section: The cliche is that it’s like the movie “Alien.” I hate to fall back to cliches, but shit…it is exactly like alien. She’s not put under general anesthetic, just spinal, so she’s awake. They put a screen across her chest, because I think if she were to look down at it, it would terrify her. The surgery is clean, well, relatively. Approximately 500cc should be lost in vaginal birth and 1l lost in c section, which now that I write it out, seems like a lot. That’s 1/6 of all of her blood lost. I don’t know why it looked so clean. I’ll try an make these quicker, as I’m writing this all down quickly and don’t really have time today to dwell on the intricacies of language and poetic subtleties.

Coffee meets bagel: I re-signed up for this. I haven’t had great success with this dating site before. I have gotten two dates last time, but it is overwhelmingly filled with obese women. I understand that they need love and they defer to online dating, but it doesn’t really boost my self-esteem when I turn them down every day. However, I did match with a 34-year-old psychologist from U of M and plan to meet her next week. We’ll see how that goes.

OKCupid: I re-signed up for this as well. There’s much more to do on this site and you can easily get lost in it. It can distort your dating perspectives to an unhealthy level. You’re choosing human beings off of a menu. I changed by profile picture to a topless mirror selfie, I’ve been working out and I think I have a pretty good torso, but I’m debating removing it as it seems incongruous with the rest of the profile.

Facebook name change: It seemed like the thing to do in light of the fact that I have to apply for residencies in the next few months.

Concert of colors: Yesterday (Saturday) I went to the Concert of Colors in Detroit with YC. We met his friend J(don’t know her last name…). The concert was very professional jazz, which I can take of leave, I’m not too into it. We had dinner at Union Street on Woodward. I told a dating story of mine from last winter and I plan to tell it on this blog as it is pretty interesting.

 

On Ann Arbor

Ann Arbor is THE college town in Michigan. I never went to U of M. Instead I went to Wayne State in Detroit, which is where I go to medical school now. During undergrad I would visit friends there often, as a good 1/3 of my high school went there. Between undergrad and medical school I did live there for a few months doing research at the eye center. I was part of the retinal team focusing on macular degeneration and the retina, particularly concentrated on human retinal pigment epithelial cells. I realize now that I didn’t live to the full potential of the city when I was there. I don’t know the area, I didn’t explore. All that I did was spent the days at the eye center and returned to my sublet apartment, covered with dozens of millipedes (or were they caterpillars?) in a hungover midday depression. I needed to spray the place every other day to kill those damn things off. The nights were spent with the few friends who remained in the city after graduation. I just drank and smoked, which I guess is fun, but I didn’t meet any new people. I was social, but didn’t end up dating anyone that summer. No new stories or relationships from an entire summer in a fascinating city.

Last march, I had a date with a girl from Ann Arbor. She was a natural blonde, which I’ve never dated before. The girl I’m typically attracted to is brunette, thin, and has blue or green eyes. I don’t know why, but that ended up being my ‘type.’ Anyways, I wanted to take her out in the town. She ended up showing me everything. It was a charming walking date, but like so many relationships, it simply fell apart without any bitter feelings. It was during that date that I realized how little I knew of the town.

I’ve been thinking of how to address real names in this blog. I don’t want to say actual names as it may out people and name names when they don’t want to be named. For anonymity sake, I think I’ll just use initials. That should work. On Friday, I went to Ann Arbor with my friend from med school YC. He loves Ann Arbor and U of M and knew the entire town. He gave me a tour of the undergrad campus, told me where to take future dates. There are some absolutely gorgeous places to take walking dates in AA. The plan of the night was to go to a comedy club, but that fell through because it was the 4th of July weekend.

People affect my extroversion. Some people are able to cloud my mind completely. I stammer around some people. One of my attendings had this incredibly aggressive demeaner. I would always stammer around her, and only her. She was completely rude, and would take her phone out when I was reporting on patients. God I’m glad I don’t have to work with her anymore. YC is kind of like this. I become uncomfortably aware of my own presentation. I stammer. I don’t know why, who cares if you’re being judged? I don’t typically care. I try to intellectualize it, but no matter how much sense it makes in your head, in person I can’t shut down the overanalysis that comes with being around certain personalities. While walking around with YC, I know I should have approached and talked to women that were interesting to me, but I had this weird feeling that I couldn’t shake simply by being around him, like I could do it, but not with him there watching me. We ended the night at a bar where I had a crappy mixture of a corona and a margarita, called a coronita. He talked about his poems and books that he’s written. He’s really prolific. It’s kind of inspiring, to be around other creative people, however, his artistic goals are so different than mine.

In all, I guess it was another empty night in Ann Arbor: no comedy show, no girls, no new friends. I did learn a bit more about the town though. Now the weekend’s over and I have to get back to work tomorrow.

First Week of OB/GYN done

I finished my first week of OG/GYN. It was mostly orientation. The only real day was yesterday. We had a quick orientation in which we learned how to set up the table in the room with the correct equipment for delivery. I introduced myself to the patient early, at 9ish, set up the table like I learned to 10 minutes before, and then spend most of the day just bumming around. I would check on her every half-hour or so, but she was just sleeping for most of the day. The room didn’t feel medical, it was like a modified hotel room. Her family was there: husband sitting quietly, mother smiling, little sister on her phone. I was ready to leave at 2, as I wasn’t really doing anything. At this point, I shadowed a resident who made it very clear that I would leave at 6pm. 7am to 6pm…alright, at least now I know the hours. 6 pm creeped slower. The patient’s fetal heart rate decreased –called “decelling.” A C-section is called for. The attending arrived and called off the C-section. She was in charge to a compelling extent. She barked orders with seasoned authority. A good-cop, bad-cop routine developed. The attending would scream at the patient to push. She pushed, lost her breath, started crying. The head nurse would soothe her by rubbing her shoulder and speaking to her in a calm maternal voice how she was a strong woman and she would soon be the mother to a beautiful baby girl. The attending would scream again and the routine would restart. I just held up one of the patients leg. Within an hour, the baby crowned, which means the head peaked out without regressing at all. The surgeon quickly performed an epistiotomy, cutting downwards towards the anus. The baby slipped out and a swift gush of water followed. The actual birth after crowning took, maybe, 5 minutes. The second the baby was out, everyone in the room rushed to do whatever they were assigned to do beforehand. The father cut the cord. The nurses took the baby and weighed her. The family followed the baby with the nurses and tried to take pictures of her fist moments on earth. The nurses told the family to return in a moment after they had finished their tasks. The attending and the intern stitched up the wound from the epistiotomy. I stood there and no one really cared, except the attending who asked me questions about the placenta and umbilical cord and the method of action of lidocaine. The nurses held up the baby next to the measurement of her birth weight so that the family could take pictures. I’m sure they posted the images online as soon as they could, her life is going to be completely documented online. I left the hospital as 7:30.

As for other events, I passed my retake shelf and won’t have to remediate medicine! I have a 3 day weekend, due to the fourth of July. I plan to go to Ann Arbor tonight. I’ll try to recount what happens there on this, thus, I hope to make it more memorable, as it will be recounted. I assume knowing that something is going to be documented will lead to more effort put in to make it interesting.

Took IM shelf

There’s a hesitation that stops me from posting anything here. I’m not used to having any sort of outlet and this is online, which is much more public than I am used to. It has the potential to be scrutinized, which then makes it more difficult to show any sort of vulnerability. But I’ll try with this as it should be an outlet.

I took my IM shelf this morning. I felt much worse than the first time, but the practice that I took 2 days ago ended up being 10 percent higher than passing. So, I’m not too worried about failure.

I started my last rotation, in OB/GYN, with the next class, so I don’t know anyone in my group, but they all look up to me for advice, at least temporarily. I’m over at Oakwood now, which is a good 45 minute drive. I should get up at 5:30 to make it there before 7.

 

Burnout in IM study week

There is a massive difference between the potential and excitement of planning and the misery of doing. My mind is constantly in the planning stage, so even when I am doing a previous plan, as is the case today, I plan on what I could do in the future. It disrupts the study and causes constant revision in plan. The plans change so much that I realized that it may not be worthwhile to tell other people any of my plans, as they invariably change. For example, my original plan for this terrible week was to read all of step-up to medicine, however, now I have changed it to simply focus on questions – they tend to be higher yield and I should be able to do over 1000 of them. That has been my plan, and, for the most part, I have been able to do it. The initial planning is an emotional crest, then the emotions sway downwards with time and execution of the plan. Eventually I am left trudging through an emotional trough, as is the case today. Everything tends to fall on a sine-wave, so I shouldn’t get too distressed as everything will come back into place. But right now, as I go through with the plan, I feel lonely and unable to reach out to any. At school and the library, where I was earlier today, I emotionally closed myself of. I secretly loathed everyone around me. Eventually it was too much and I had to leave, had to come back home, where I could at least be alone with my loneliness.

I met with mentors over the course of the week and decided that I would pursue family medicine, hopefully in a rural and unopposed program. This means that family med doesn’t compete with other fields (e.g.: OB for deliveries). However, I set up to meet with the family med adviser and she said she wanted to meet with me anyway to discuss continuity clinic. That is a 6 month clinic that I went to every week. I have a strong suspicion that I either failed and will have to retake it. Why else would she want to discuss it?

Also, it should be noted, that today the SCOTUS ruled in favor of gay marriage. Even when I try to seclude myself, I can’t help but be surrounded by this fact. It is all over facebook, reddit, and even my messaging group. When older people and parents are asked about their lives, retrospectively they anchor personal life events to world news. This is the case here as well. I can say, “when gay marriage was legalized in the US, I was burned-out studying for my makeup internal medicine shelf in the week I was supposed to have off.”

 

Change in plans

So much happened in the last couple of days. First and foremost, I found out that I failed my internal medicine shelf and the remake is on July 1st. This drastically changes my schedule over the next week. I need to drop reschedule my Step 2 CS, which was going to take place on July 11 in LA. Now, there’s no way I can study for both. I have no I idea why I failed. I can only account for it due to the fact that I spent too much time on questions an not enough on reading. I plan to read all of step up to medicine over the course of the next week, which is 70 pages a day. Goddamn this sucks…so much for having a break between internal medicine and OB/GYN.

The new diet is actually going really well. It all cooked up more delicious than I expected. The plan has you eat 3200 cal one day and 2900 the next. I cooked enough for this plan and I can’t eat anywhere near the recommended amount. I stopped counting the calories and started simply trying to match the plan. I ate 5 meals today, when it scheduled 6.

Due to the new change in plans, I can’t really meet up with any of my friends. They met for drinks yesterday in Ann Arbor and today they went to Buffalo Wild Wings in Dearborn to watch the US vs Colombia game. I just have to push through the next week without burning out and I’ll be fine.

The library is such an interesting place. You see way more kids and old people than anywhere else I normally go. There’s also, for some weird reason, a lot of gorgeous girls all over. My friend said that once you get out of your head, the library was the best place to pick up girls. I would go up and talk to some of them, but then I rationalize that I have 70 pages to read. I’ll worry about all of this after the week of studying. Damn.

Plans as of 6/20/2015

I have always had plans focused on the distant future, the next few weeks, and the day. It becomes very easy to lose track of plans and become depressed with lack of results. Therefore I plan to write up a plan today and revisit it in 3 months, at the end of September.

Long Term Plans:

Take step 2 cs on July 11 in LA. OB/GYN rotation takes place July and August. Then take the month of September off to study and apply. Send out ERAS to schools in mid September and take Step 2 CK at the end of September.

Figure out what to specialize in. I have been telling everyone that I was going into pathology for the last 3 months, but now it seems like that would simply be…boring? Too comfortable? What I realized recently is that everyone has their own personal legend (a term I took from The Alchemist), in which they drive themselves internally to achieve a goal that is personal to them alone. For me, I have been thinking about going abroad and either doing the Peace Corp or WHO or Doctors Without Borders. I have contacted the recruiter for the Peace Corp, however, I don’t know if it would be worthwhile to do, as it may be very difficult to bounce back into a grueling academic setting after doing something so different for 2 years. I told my Dad yesterday about my desire to go abroad and he told me to go into family med as that is a universally understood field that is chronically in demand. You just sacrifice status and pay relative to other fields. I’ll think about all of this.

Approach more women. I have tried online dating and briefly dated a girl this last year, but I have not been satisfied with this situation. A few years ago I read up on pickup and I read forums and subreddits about it. I know the theory, but theory is completely in vain without any practice. Practice is the only thing that matters. It just comes so unnaturally to me, as I assume it does for everyone. An effort must actually be made on my part to change this. Realistically what am I going to do though? I can’t go to clubs in the middle of the week – or even on the weekends now that I think about it…Online dating was OK, and I’ll just take a break from it until I’m done with OB/GYN, just to clear my head and work on myself. Instead, I will try to approach in the daytime. This is much easier to rationalize yourself out of, however, I should be able to hold myself more accountable with this blog…I’ll do more approaches and write about them here. The worst thing that happens will be that I end up with a story.

Write: I wrote a book between 25-27 and gave it to my cousin to edit. I should get in touch with her…Apart from that, I need to start a new project. I have the notes for another book like the first, however, the first one wrapped up well enough to make anything similar to it feel derivative. I tentatively have a plan for a detective story.

Music: I have the ideas for an album, however, I don’t have the manpower. The plan is to create song demos, then contact people who can help expand each song, then to record a final version in a studio. Put it for free online. The point is to create. You’re not going to make money in music. So, I need software and to set up for recording.

Daily plan

There are 5 things that I plan to do every day. When I do them all, I put an “X” on my calendar. Ideally I would have a chain of “X”s in a row and I would have further incentive not to break the chain. However, the longest chain I had was 20 days. I think writing this in this blog will help out. The 5 things are

1. Diet: I have simply tried eating less that 1800 calories/day. That was the only restriction. That’s how I’ve been for a few years. Recently though, I plan to try something new. I googled “How to get a 6 pack” (I know, I know…) but I came across a 8 week diet plan from Men’s Fitness. If I coordinate it right, I’ll cook everything on Saturdays (which is what I did today) and plate everything the night before for each day. This takes a long time on Saturday, but it shouldn’t take too long in the week. Hopefully I’ll see some change in 8 weeks.

2. Exercise: I really just plan to workout every day for 20 minutes. I have a 5 day cycle: Arms, Delts, Chest, Back, and Legs. Consistency is key here more than a definite goal. The gains will really be made with adherence to the diet.

3. Meditate: I have found this weirdly difficult to do. It always seems like a chore, even though I realize I can think clearer after and that I become more productive. I’ll try to do this first thing in the morning and before any studying.

4. No Porn: This one is pretty easy once I get away from it for a few days. The benefits are much more mental than the other things on the list. It affect libido by giving an artificial stimulus to a real human instinct. Without the stimulus, libido and sexual response feels much more natural. Relapse with this usually was due to the fact that I lumped all 5 together. I would say, “Oh I ate too much today. I won’t be able to mark an x on my calendar. I may as well see what porn I’ve missed.”

5. Questions: I have tried to do at least some questions from a Q bank every day, either Kaplan or USMLE World. As of now, I finished the first pass of uworld and still have the majority of Kaplan to do. However, I am around 30th percentile in uworld because I rushed it just to finish. I need to redo them until I know them solid. Then the plan is to get “Doctors in Training for Step 2 CK” for September. In fact I should get that now.

Alright, now that I’ve written out my long-term and short-term plans I feel pretty motivated! I made a note in my calendar on my phone to check back to this post in 3 months to see how it all goes.