Graduation!

This past Friday, Tony and I graduated for the third and final time.   Even though we have been through high school and college graduation ceremonies, this experience really was the one we had been waiting for.  I remember sitting in Uris Library at Cornell studying organic chemistry thinking that medical school was an eternity away.  At the start of med school, 2012 was a fantasy time that seemed would never come.  And, sitting here typing a few days later, it still feels pretty surreal to finally be a doctor.

For the ceremony, Docapella (our medical school Acapella group that Tony and I participated in) had its final performance. 

It was pretty cool to go out in style singing the national anthem.  And, we had a lot of fun getting the ole' group together again in the days leading up to graduation.  It felt great to end on a good note (lol... bad pun).  

During the ceremony, we each received our rolled up diplomas (the REAL thing) one at a time.  When making our way to the stage, we handed a card to Dr. Severin (our dean for 1st and 2nd years of med school) with the phonetic spelling of our names for him to announce.  I think in some cases the phonetic versions were harder to make out than the real name.  Regardless, Dr. Severin made it look easy!

I snuck in a quick hug for my husband before we each were “hooded” on stage (having our graduation hoods placed on each of us by a few of the doctors whom taught us).  We all signed the “doctor’s book,” which contains the first doctors' signatures for graduating physicians from UB. 

My favorite part of the day was spending it with family and friends.  Even though we looked like we had just stepped out of the Renaissance in our silly hats, we made sure to get a bunch of pictures (thanks, Dad, for weathering the crowd to get the photos!!).  We missed my sister, Liz, but know she has been hard at work getting things underway with the new job!  Tony and I were grateful to have so many family members there to celebrate.

Family Dinner at the Murek's!

Last week, Tony and I celebrated Easter with Lori, Mitch, Shelby, and Rob.  Unfortunately, Haley and Josh couldn’t join us, but hopefully next time!  We had a lot of fun, and Butters thoroughly enjoyed himself as well.  We look forward to these dinners together as a family.  Weekend trips home, like this one, have helped keep us grounded during our time in medical school.  It makes me sad that they won’t be as often when we move to Texas next month.  However, they certainly will give us a great incentive to come home!

Mitch made a new cheese dip!  It was so tasty, especially paired with the mini sausages. 

Mitch loves to take new recipes and add his own finishing touches.  He has done this in the past with stews and soups, which always are a big hit!  This time was no different, as I couldn’t help but have a few extra samplings! 

These two crack me up! What a great couple!

Shelby, Tony's sister, met her boyfriend, Rob, last year.  They go to college together at Niagara University, and it is obvious that they both kinda like each other :) Even though I have met Rob a few times in the past, this was the first time we really had a chance to sit down to chat for a while.  Both are doing great in school.  They are carefully considering career choices, and thinking about grad schools: law for Rob and education Masters or PhD for Shelby.  However, it seems their hardest decision right now is deciding on the kind of dog to join them in the coming years:  Rob is not too keen on the Maltese that Shelby wants.  However, we are working on him :)

Lori made two of my FAVORITE dinner items: twice baked potatoes and seasoned steaks right off the grill. 

Her twice-baked recipe is so good.  She bakes the potatoes first, cuts them in half, and scoops out the potato center.  Using a mixer, she beats the potatoes and adds cheddar cheese plus real bacon (sometimes also sour cream).  Each is topped off with some bacon bits, after stuffing the mix back into the potato shells.  They are baked in the oven for a second time and come out absolutely delicious. 

The steaks came from the Alabama Store, which has the best cuts of meat I have ever tasted.  After adding some seasoning, Lori cooked them to perfection on the grill… didn’t even need steak sauce!

The meal was topped off with this delicious two-tiered cake (vanilla with a raspberry center).  Aren’t the peep decorations a great idea for Easter?  So creative

I liked this cake so much, I just had to pin it (I love Pinterest!)  And, the jellybeans were Tony and my favorite: Starburst Jellybeans!

Butters of course was also pretty happy with the whole visit.  

With all of the food around, he certainly was on his worst best begging behavior. The plate of chocolate eggs had to be temporarily moved, as we all knew what he was thinking by the crazy eyes over the coffee table.  I am pretty sure that he had a few helpings of mini-sausages, as he smelled a bit of BBQ sauce by the end of the night.  Grandma Lori surprised him with a new sock monkey, which he thoroughly enjoyed when he got home.  But, during the visit he preferred to test out one of his all time favorite toys: the good ole’ paper towel cardboard roll.  

As always, a fun and memorable visit!  

Fourth Year: The Final Stretch

Fourth year is pretty much amazing.  After the stress and intense learning curve of third year, fourth year is a brief moment in time where you can take a step back and take a breather.  There certainly are stressors between applying for residency and finishing up rotations.  However, it is the last time before residency that you can really have some solid break time.  And, by the end, you will be a doctor!

Rotations

I had a chance to take some pretty neat rotations this year.  There are a few required rotations (Advanced Medicine, Neurology, and Surgical Subspecialties), but the rest you get to choose. I completed 3 psychiatry rotations (general psych, psych ER, and hospital psych consults).   I participated in a Forensic Pathology rotation, assisting in autopsies at the county morgue.  Through a Faith in Medicine course, I worked with patients at Hospice and free clinics. 

Board Exams: 

We had to take 2 additional board exams: Step 2 CK (Clinical Knowledge) and Step 2 CS (Clinical Skills). 

CK:

CK is similar to step 1 in that it is multiple-choice format.  However, it is a bit longer and centered more on clinical medicine.  Luckily, most students find it to be a bit easier.  It took only 3 weeks to study for this one (vs. TEN weeks for step 1). 

CS:

CS tests your ability to interact with patients.  This should be a pretty easy test by the end of medical school, as it incorporates skills you have been developing over the last 4 years.  Largely, I think it is an expensive way to be sure that (1) you can speak English and (2) you feel comfortable interacting with patients. 

CS tests your ability to interview a patient, write up the encounter, and come up with a differential diagnosis (list of conditions the patient could possibly have based on symptoms).  The exam takes place in an office-based setting.  Unfortunately, there are only a few places to take the exam in the U.S.  Tony and I chose the closest site we could find, which ended up being Philadelphia, PA.

For Tony and I, the logistics of the CS exam were more challenging than the exam itself.  Stupidly, we waited for the weekend before the exam to arrange our hotel accommodations.  Needless to say, we didn’t have the best selection.   We ended up at probably the sketchiest hotel in Philly.  You know you are really in trouble when you see this on your room door:

However, I can’t complain too much as we did make it out alive and passed our exams!

Interviewing and the “Match” Process:

During fourth year, most medical students travel across the country interviewing with potential residency programs.  It is a time-consuming, exhausting, and expensive process.  However, most students find it to be a really valuable experience.  It allows them to get a feel for many programs and end up somewhere they really like.

All medical students must go through a “match” program.  For most students, they go through the NRMP match, which is a nation-wide matching system.  Med students can “couples match” (enter the process with another student) or match singly.  Students select their top choices for programs, and each program also ranks the students that have interviewed there.  If the program ranking is similar for both the student and the residency, the student will end up a resident at that location.  Students find out in March (Match Day) where they will be going! 

For Tony and I, our process was a little bit different.  As military medical students in HPSP (a program for students who will commit time to the military in exchange for a medical school scholarship), our match pool is smaller.  It is a more intimate process.  Students rank their programs, which can include military and civilian programs. In November, all of the specialty program directors for each military residency program actually meet together and decide on their residents.  It is not an automated system like the national match.  They take into consideration the students’ choices.  We couples matched through the military, and found out in December where we would be going.

Our interviewing process was MUCH easier than the average medical student.  We had the opportunity to interview with our program directors during our away rotation (medical rotation done at a military site).  We liked our programs so much that we didn’t interview anywhere else and only ranked one program each (this is NOT generally recommended, but worked our really well for us).

Away Rotation:

We LOVED our away rotations in San Antonio.  My away rotation experience really couldn’t have been any better.  I loved the patient population I worked with, which consisted largely of current military members and veterans.  In the psychiatry program, the staff and students worked so well as a team.  I could really see myself fitting into that clinical environment.  It was my first real look into residency life.  Also, Tony and I had a chance to catch up with our friends, the Sky family, as well as our military training friend, Mamie. 

The location was a pretty nice icing on the cake.  San Antonio is a beautiful city, with so many interesting places to explore including the River Walk, King Williams District, the Alamo, and a ton of great restaurants.  But, I would have to say that the weather really sold me.  I loved that it was pretty much always warm and sunny… a welcomed change after the seemingly endless cold winters in Buffalo (although this past mild winter was a welcomed surprise)

Letters of Acceptance and MATCH DAY!!

As part of the military match process, we received the great news in December that we had both matched San Antonio for our programs!  It was a HUGE weight off of our shoulders to know so early where we will be going.  It certainly made the rest of the year really enjoyable.

When March came, the rest of our classmates found out where they would be headed.  On Match Day (when everyone learns where they will be going), each student receives a sealed envelope that contains the program he or she matched into.  Even though Tony and I knew what was in our envelopes, it was great to watch the feelings of trepidation turned into excitement as our classmates received their matches.  We were so happy for all of our friends, and most students were really happy with the results. 

                   

Time off:

At my school, students are given three months of time off from rotations.  It is intended that these months be used for interviewing, studying for/taking board exams, and preparing for residency.  Due to the very small time commitment incurred by our interviewing schedule, Tony and I ended up with a lot of extra time off!

If you have been reading this blog or following my Facebook, you will know that Tony and I added a furry friend to our family.  Of course, raising a puppy (even though we cheated and got him at 6 months) was a time commitment.  We are enjoying watching him grow and fit in with our family.  It is now hard to imagine our life without him!

We also spent a lot of time with friends and family!  This is likely the last year in many where we can spend multiple holidays with family.  We enjoyed Easter, St. Patrick’s, Christmas, and Thanksgiving celebrations.  What a blessing! 

The last four years have been a whirlwind.  It was incredibly challenging working our way through med school, and it is a great feeling being at the end looking back. We look forward to the next step as we begin residency.  However, we are thankful for the experiences that led us to this point.

Third Year (Part Dos): The BIG One

So, the intended 4 posts for med school has turned into 5.  However, I realized a single post for 3^rd year really wouldn’t do it justice.  This year was so packed that I could probably devote another 4 posts just to this year.  Here is the rest:

Obstetrics and Gynecology:

This field is all about women’s health.  These doctors care for women before, during, and after their childbearing years.  As a result, they become very attuned to the health concerns striking women in each stage of their lives. 

 The Ob/Gyn wears many hats.  This field is one of the few that incorporates a combination of clinical medicine and surgery.  These doctors devote their time to many different practice environments.  They can be in the clinic doing routine examinations, prenatal examinations, fertility counseling, or postnatal checks.  Other times they are in the delivery wing helping to bring new life into the world.    And sometimes they are in the operating room performing repairs, hysterectomies, or other surgeries for women.  It is another field with long hours, and you are faced with the challenge of balancing many different roles.  However, it provides a great deal of variation in your day to keep things exciting!

For third-year students, it is another rotation that requires a large time-commitment.  Just like the docs you work with, you have to divide your time among these numerous practice settings.  Here are some of my favorite OB/Gyn moments!

- Delivering babies!  Mostly I had the opportunity to deliver placentas (the sac that holds the baby during pregnancy, which is delivered after the baby).  But, I did have the opportunity to deliver a couple babies.

- Waiting 12+ hours for the half-hour rush of the delivery

- Seeing first-hand the devastation of ovarian cancer

- Watching the tears of joy from a couple seeing their baby on ultrasound for the first time… and discovering they are having twins!

- Being first-assistant on a hysterectomy, and helping the patient through pre and post-op care

- Discovering the importance of prenatal care.  The blood work your doctor recommends is important! 

- Feeling the depth of a woman’s sadness after a miscarriage 

- Giving a baby to her mom and dad to be held for the first time

- Catching soon-to-be dads before they pass out in the delivery room

- Realizing that when I am someday asked the question, “Do you want an epidural,” it will be a resounding “YES!!”

- Discovering how much of a miracle it is to have a healthy baby

- Becoming an expert at finding baby heart-rates, measuring fundal heights, and estimating cervical dilatation

- Helping a woman prepare to be a mother, whether she is ready to be or not

- Mastering the art of the painless pap-smear

- Experiencing baby fever!  Despite the long hours, seeing all of those moms really makes you want to have a little one of your own.

Pediatrics:

I loved pediatrics.  There is something about being around children all day long that makes work fun and interesting.  This was certainly a field I could have gone into, and definitely was at the top of my list for possible careers.  You have a chance to work in hospital and outpatient settings.  It is rewarding to watch your patients grow up from infancy into adulthood.  You can help to foster a healthy lifestyle that will stay with your patients for a lifetime and see them at critical moments in their young lives.

However, one of the hardest parts about pediatrics is seeing the really sick kids.  There is nothing more devastating to a parent than the death of a child.  There are times I really wondered how doctors can handle being pediatricians and parents.  I know that if I was seeing sick kids all day, I would be in constant fear of my own children becoming ill too.

Here are some of my pediatrics moments:

- Treating children is like caring for aliens.  Their lab values are different, they are affected by an entirely different set of diseases, and you never can quite expect what they are going to say/do next!

- It is amazing what kids will be willing to do in exchange for a colorful sticker

- There is nothing quite like starting your day in the nursery!  Few things in life match being surrounded by a bunch of cuddly, (mostly) sleeping little bundles of newborn joy

- Learning what to expect when I have my own children

- Getting an even stronger feeling of baby fever!

- Seeing the fear in parents’ eyes when they bring in their sick kids, and the relief when they get better

- Never unsuspectingly open a baby diaper.  Otherwise, you are likely to get peed on.

- Get to know your baby poop colors!  They actually mean something

- Get your children vaccinated!  There are few things more certain in medicine than the contribution of vaccines to preventing childhood illnesses. A brief “ouch” is much better than the risk of contracting a life-threatening condition.

Psychiatry

Of course, I had to save my favorite for last.  I am especially partial to psychiatry, as it is the field I will be devoting most of my life to.  Before med school, it really wasn’t a field that I had considered.  I realize that I had a lot of false, preconceived notions about the field.  Prior to starting med school, I didn’t really understand mental illness as a pathological process.  However, just like heart attacks, broken bones, and diabetes, there is a structural and chemical basis to diseases of the mind.  Understanding this helped me to see how medicine plays directly into the treatment of mental disorders.  Diseases of the mind really affect the whole body; they can be physically and emotionally debilitating.  I realize how challenging and rewarding it can be to treat patients with psychiatric illnesses.  It requires not only a strong medical background, but also an understanding of people and effective communication.

While already fairly specialized, psychiatry offers many choices for practice environments and focus.  You can work in an emergency, clinic, or hospital setting.  Practice styles involve short-term care, like through the consult services, or long-term care through inpatient or outpatient services. 

Here are a just few of the memorable take-aways:

- I once was asked, “Are you that princess from England [Kate Middleton]?” Although I bear absolutely no resemblance to her whatsoever, other than we both are women in our 20’s, I couldn’t help but smile. 

- Carrying on a conversation with a person with mania can be a challenge.  It is unbelievable how quickly these patients can talk and the rapidity with which they change topics.

   

- It is incredibly rewarding to be there for a person in his or her greatest moment of need.  A person is never in a more desperate situation than when they are considering or have attempted suicide.  You often are the last line, and what you do next can sometimes be the difference between life and death.

- Seeing a patient with schizophrenia before and after hospitalization.  Medications can really work wonders

- Treatment often takes a lot of time and patience.  Sometimes it can take weeks, months, or years to effectively help your patient.

- Marijuana is not harmless.  It can sometimes make you psychotic

- Trying drugs is a bad choice, especially if there is not a drug test yet for that substance.  That is a great way to end up in CPEP (the psychiatric emergency room)

- Get collateral!  It is the best kind of lie detector test

- You have to truly understand the whole patient.  You have to learn how the body language, speech pattern, word choice, and conversation content all come together.  You have to see a lot of people with the same disease and constantly read about the basis of these processes.  It takes tremendous training and skill to effectively diagnose and treat a patient

Third Year (Part Uno): The BIG One

This is the year you have been waiting for.  It is The. Big. One.  Regardless of what you thought you wanted to do coming into medical school, this is the deciding year.  By the end, you will figure out what kind of doctor you will become.  The hours stink and you will be exhausted.  You will have to work all day and study most nights.  However, you will be doing REAL medicine (while under the close observation of actual doctors). 

Regardless of how well prepared you think you are, you can expect to look completely stupid at least a handful of times during third year.  There is a steep learning curve as you discover how to apply all that information you gathered during the first two years of medical school.  However, somehow by the end of it you come out ready to be a doctor.

Surgery:

Surgery is about survival.  It doesn’t matter if it is a routine procedure or life-saving operation.  Patients are never more vulnerable than when they are on the operating table.  During moments in the OR, their lives are truly in the hands of another person.  Even though it was only for 12 weeks, it was absolutely amazing to see a surgeon at work… most often from the far end of a retractor. The patient comes in broken, and if everything goes right he or she leaves fixed. There is no other area of medicine with more instant gratification.

From the side of the medical student, it is also very much about survival.  For anyone who likes sleep, surgery is not for the faint of heart.  You can’t fully prepare yourself for that kind of sleep deprivation.  Before the rotation, I could not fathom the incredible effort it takes to write a patient note after being awake for 30+ hours and not fall face first into my coffee.  I quickly learned that surgery is not for me.  The time in the OR is amazing, but you have to sacrifice an incredible amount of time and energy to get to those brief moments in the surgical spotlights.  The training is grueling and life as an attending often requires similar sacrifices.

Most of my surgery months truly were a blur, as I shuffled through in my sleep-deprived haze. However, here are some of my surgery moments

- Living on crumbled chewy bars from my white coat pocket

- Trying to cram factoids from the “Surgical Recall” handbook into my head 2 minutes before heading into the OR to be “pimped” (drilled with questions) by my attending

- Learning to write the shortest patient notes known to man

- Telling a mother her son is alive

- Successfully inserting a foley catheter (designed to drain urine from the bladder)

- Gowning up in under 10 seconds for trauma calls

- Learning second-hand it is never a good idea to insert a chest tube through a stab wound

- Being first assist on an emergency thoracotomy (procedure where an incision is made through the chest to gain access to the lungs and heart)

- Mastering the art of sleeping while standing up

- Always carry steri strips, gauze, a suture-removal kit, and scissors in my pocket

- Learning that going to the call room (a place where physicians try to sleep between calls) is just asking to get paged

- A good idea while drunk is a great way to end up in the ER (and possibly OR)

- Seeing the many ways you can be injured while riding horse, motorcycle, four-wheeler, or Jet Ski… and wondering if I will ever get on any of these again

- NEVER stand directly behind the patient when giving an enema

- Always be nice to the nurses!  You can learn a lot about drawing blood, taking samples, and finding things in the crowded supply rooms if you are considerate and thankful

- The simplest things, like applying pressure to a bleeding wound, can save a person’s life

Family Medicine:

When people hear the word “doctor,” many immediately think of the family doc.  I remember going to my family practitioner with my mom as a kid.  My visits to that office were my first exposure to medicine.  When I came to medical school, I wanted to be a family doc.  Family physicians are able to work with patients in all stages of life.  And, they have the privilege of watching their patients grow and change, providing them support for whatever life brings.  They have to know a little bit about everything.

My family medicine rotation was divided between inpatient (hospital) care and outpatient.  It was my first real opportunity in medical school to have ownership over a group of patients.  On inpatient, I enjoyed speaking with the same patients each day, writing notes on their progress, and knowing that I was contributing to the team.  During outpatient, I could see patients daily and write notes before the doctor came in.

Some memorable moments included:

- Managing a patient with an MI (heart attack) successfully from start to finish, and watching him leave with his family by the end.

- Helping a family to transition their loved one into Hospice care

- Learning to read ABG’s, CBC’s, and CMP’s (lab results) in under a minute

- Hearing a baby’s heartbeat for the first time through a pregnant belly

-  Managing an 80-year-old’s blood pressure one minute and then performing a physical on an infant in the next

- Learning wine tours are a great way to get acute pancreatitis

- Following patients in the hospital and later seeing them in the office

- Meeting a couple that has been married for 55 years sitting together and holding hands.  Each knew more about their spouse’s medical conditions than their own

- Learning how to quickly and accurately do physicals on 4 squirmy children… at once

- Realizing that sometimes patients just need someone to talk to

Internal Medicine:

Internists are some of the smartest doctors I know.  It is not necessarily because they were the most talented in medical school or that they earned the top grades.  It is because the training pushes these doctors to gain an in-depth understanding of the diagnosis and treatment of the broad range of illnesses affecting the adult population.

Unlike Family Medicine, Internists have wider opportunities for fellowship training.  In internal medicine, you can choose to be a general practitioner, working as a hospitalist or primary care doc, or you can select a specialty.  Opportunities for specialty training exist in 18 different areas including hematology, cardiovascular disease, gastroenterology, rheumatology, and nephrology.

During my 12-week internal medicine rotation, I again had inpatient (hospital) weeks and outpatient weeks.  Here are some of the lessons I took away and moments I remember.

- It is incredibly difficult to balance 10+ medical problems and 20+ medications in a single patient

- Unfortunately, patients can have more than one cancer at once

- Discovering how to quickly read CT scans and chest x-rays

- Being in the hospital can sometimes be the most dangerous place for a patient.  Bacteria are some of the deadliest killers known to man.

- Always make time for family meetings.  You often need to treat the family, not just the patient.

- Learning is a constant process.  You always can be reading more articles and textbooks or attending more lectures.

- My crowning moment as a medical student: diagnosing a patient with pheochromocytoma who had been seen by multiple doctors and had been misdiagnosed for months.

- Medicine is a constantly changing field.  What is the most current treatment today may be completely done away with tomorrow.

- Ordering more tests can sometimes confuse the picture, not make it better.  Only do what you need to for the patient.  Less can be better

- One disease I never want to get: necrotizing fasciitis. 

- Take pride in the little things.  Sometimes it is a huge accomplishment to simply get a person to eat a meal, sit up in bed, or go to the bathroom

- Always get your vaccinations!  A couple seconds of pain beats a couple weeks or months in the hospital  

**** Blog post part 2 of third year coming shortly

Second Year: Transitions

Second year was one of those strange in-between years.  You have survived first year, but don’t know enough to be fully let loose into the clinic.  The good thing is, you know what to expect.  You come back from a summer off (likely the last on one until retirement), and know you are going to jump headfirst into coursework again.  You know that classes and studying will dominate your days, and you will again get to know the lecture hall as well as the back of your hand. 

Classes:

At my school, second year continues with organ-based modules.  A few weeks are spent learning about the main organ systems including the circulatory system, respiratory system, digestive tract, etc. Clinical opportunities continue to be available, as every other week you still spend a day with a new preceptor. 

The Boards:

The biggest difference between 1^st and 2^nd year is the dominating thought on students’ minds: Step 1.  To become a licensed MD, you have to pass four large, challenging exams: Step 1, Step 2 CS, Step 2 CK, and Step 3.  Step 1 is notoriously known as the hardest of the step exams.  The test has seven blocks of 60 minutes, each block containing 48 multiple-choice questions.  And, the questions are hard.  It is quite possibly the most important score for residency applications.  Being the first exam, you aren’t quite sure which study methods will or will not work for you.  The test covers everything from first and second year of medical school, including a lot of foundation concepts that are not covered in the other exams.  And, of all of the boards, it is the least clinical.

My experiences with Step 1:

- Planning a wedding while studying for boards was a better decision than I thought it would be

- You really can study for 10+ hours per day… everyday… for weeks… and survive

- You need some entertainment during the day to break up the monotony of studying.

- Fewer are better.  Every time another student would talk about a new great book found to study from, I would get the urge to go out and buy it.  After a few weeks of jumping between different books (and wasting quite a bit of money), I discovered it is better to choose one or two thorough sources and do practice questions

- Get some exercise.  Running everyday kept me sane

- Don’t forget to go shopping.  You will need snacks

- Leave some time for vacation at the end

Living with Medical School:

Of all of the years of medical school, I feel second year was the most eventful in my personal life.  It was an exciting year, full of changes and milestones!

- Tony and I bought our first home!  After the disaster of living in our apartment, it was a welcomed change to have a place of our own.  We loved making our little 2-bedroom house a home.  Tony and I enjoyed our adventures to estate sales as well as repainting and redecorating.  We also learned that surprises come with new homes as well.  We didn’t realize it when we bought the house, but the previous owners had a little dog that peed on the carpet in the living room… a lot.  The carpet was only 3 years old (the date was on it), and it had at least 100 stains covering just about every inch.  It was not fun ripping that up, but were overjoyed to see the wood floors underneath. After refinishing the floors, it changed the entire feel of the downstairs

- Tony and I joined the acapella group at our school, “Docapella,” even though neither of us is especially great or even good at singing.  I discovered I am definitely more of a backup singer than a soloist.  However, we made a lot of new friends.  Erik became such a good friend to Tony and I that he became the best man at our wedding later that year!

- We made new friends!  This year, we started spending more time with Matt, another medical student, and his super cool girlfriend (now fiance!!), Ashley.  The dinners, football/super bowl parties, school formals, and movie nights that followed created some of my favorite memories during medical school.

- Tony and I got married!  Growing up, I never was the girl who walked around in my mom’s wedding dress imagining the day I would walk down the aisle.  For me, it has always been more about finding that special person than preparing for a single day.  Deciding on our wedding date was more last minute than we had anticipated.  We only had 4 months to plan the entire event!  We decided on a small wedding with a large reception a week later.

We were shocked by how much enjoyment came from planning this event.  Tony surprised me and really got involved in every detail.  We reconnected with old friends, and were blown away by the generosity from friends and family.  The wedding shower, bachelorette/bachelor parties, and wedding day itself were incredible.  

(Photos by Nathan Lyman, www.tru-e-motion.com)

I will never forget looking down the aisle at my husband and seeing how emotional he became when he saw me.  Certainly an amazing time in our lives!

First Year: Survival

First year is like being an infant all over again.  You are tossed into a new environment with a set of instruments you have no idea how to use.  There is this whole new language of medical lingo you have to learn.  No matter how many times you practice saying those fancy words in front of the mirror, you still sound like a total idiot when you first try them out in public.   And, regardless of how much of a people-person you think you are, seeing your first patient somehow still ends up awkward.  First year is very much about survival, trying to make it through without forgetting why you went to medical school in the first place.  And, with the many hours dedicated to class work each day, it is pretty easy to say, “What was I thinking when I signed up for this?!”

White Coat Ceremony:

- This is the first time you really think, “I am going to be a doctor.” This is probably the pinnacle moment for most first-years.  Unfortunately, it comes at the beginning of the year. 

-Gathered with friends and family, you feel super important putting on your shiny new (short) coat for the first time.  However, within a few short days, reality sets in and you realize it is a LONG road between putting on a white coat and becoming a real doctor.

Orientation Week:

- With med school classes being pretty small, you really do get to know most of your classmates in just a few days.  Information does have a way of quickly getting around, even if it isn’t 100% accurate.  I remember a classmate sitting 2 rows behind me during orientation and exclaiming, “Did you know that there are these two students, Tony and Laura, who already got ENGAGED?!”  I guess she didn’t know we actually knew each other before med school… and had been engaged for a year.

- People really do remember first impressions. It can be alarming how much of orientation stays with you over time. 

-I must have heard 100x that week that “all of you were the top students at your colleges, but not everyone can be in the top at med school.  Most of you will be in the middle, and that is ok.” I remember thinking that week even if I didn’t say it out loud, “bah I know I can be at the top.”  Then real classes started. The middle didn’t look so bad after all.

Clinic:

- At my school, we each are assigned a clinic to work at once every other week during the first year.  This is the first opportunity to really work with a “preceptor” (a physician).  After many hours studying and going to class, clinic days helped to keep me in touch with the whole goal of medical school. 

-There is a huge difference between a 4^th and 1^st year med student.  Watching the 4^th years in the office, I was absolutely in awe.  I thought I would never get to that level.  Then I became a 4^th year.

- It is incredible how much patients can teach you.  You can spend hours studying medical conditions, but nothing matches the power of hearing a patient’s story.  I still remember learning about Paget’s Disease, Steven Johnson’s Syndrome, and Celiac Disease from some of my first patients. 

- You make lots of mistakes, but generally patients are pretty kind about pointing them out to you.  I remember the first time I used my otoscope (meant to be used to look in the EARS) it didn’t go so well. After nearly blinding and poking out the eye of my patient, she laughed and suggested I try “that other one there on the wall” --- the ophthalmoscope.

Class work:

-In the first year, most of your time is spent in the classroom. You spend so much time in one room that the smell of the lecture hall becomes engrained in your nostrils.  That memory is so strong, I still feel transported back to first year when I enter it again.

-Even though there isn’t any assigned seating, pretty much everyone sits in the same spot everyday.  It is humorous to see that when changing rooms between first and second year, people continued to still sit in the same general spots they established first year.

- You have to master speed-learning.  An entire semester's worth of material is crammed into 2 weeks.  There always is another test around the corner.  Until the end of the year, it really doesn’t let up.

-Books.  Lots of books. And notes.  And books (the picture on the right doesn't even touch the surface of the books that I have collected over the last 4 years).

- Bring snacks and coffee.  Lots of coffee.

Anatomy:

- This was by far the hardest but most interesting class I took during my first year.  Everything was completely new: it was the first time I had seen a dead body.  I really knew nothing about the human body other than “the leg bone is connected to the knee bone.” 

- I have so much respect for the people whom donate their bodies to medical schools.  It is a gift that has contributed tremendously to my education as a medical student

- On the first page of my anatomy dissector, it called the cadaver “the first patient.”  While true, I find it ironic my first patient already was dead.  Probably not a good precedent to set.  

- There is nothing worse than spending hours dissecting in search of a nerve, only to discover you already cut it about half an hour ago.

- It is NOT cool to wear your anatomy scrubs outside of the lab.  Not only are they the most unattractive color discovered by man (at least mine were), you really do smell worse than you think

- Don’t bring your anatomy books to the lab.  It is disgusting to see grease smears on pages while studying during dinner.

Outside of the classroom:

- One of greatest lessons I learned first year was the importance of having a life outside of medicine.  I realized that when you spend all of your time around other med students, you could easily get in the habit of always talking about medicine.  You have to keep things other than medicine in your life, and encourage friends to do the same.  Get some low-maintenance hobbies.  Watch some low-budget films.  Find some great restaurants.  I found I am much happier, and a better med student, when I find that balance.

- You need a place you can sleep.  Living in a ground-level apartment was a horrible decision.  The neighbor above us was awful, and I am pretty sure I could write a novel from the relationship problems I heard about through the ceiling at 3AM.  There was no greater relief than the nighttime silence that came when we moved into our house.

- Apartments offering only street parking in Buffalo, NY are a bad idea.

- You need a support system.  Family and friends kept me sane during this long road. 

- I never would have made it through without my husband.  For us, it was helpful that we both went through medical school together.  However, this is a situation other people may not feel so comfortable with.  For us, it just works.  We are always a team, helping each other along the way.  Decisions are made together, from careers to what to have for dinner.  We are each other’s greatest fans, and at the end of a hard day we can depend on one another.  Studying together, we always support one another and never make it about a competition.  

My Medical School Journey

I make a habit of not blogging about medical school.  So much of my time is already dedicated to becoming a doctor. Between long hospital/clinic hours and returning home to study, every waking hour can easily be eaten up by medicine.  It is nice to have a few moments spared from research articles and treatment modalities.  This blog, photography, raising a dog, spending time with Tony, laughing with family, visiting childhood friends: these are the ways I have retained my humanity while becoming a doctor.  They are the small corners of my life I resist letting medicine take over.  I have learned you can obtain outstanding board scores, ace every class, read endless numbers of books… and still be a horrible physician.  It is incredibly important to find balance in any field of medicine.

As an exception to my own rule, I will be blogging about med school over the next couple of weeks.  Graduation is right around the corner.  In 2 weeks, I will forever put away my short white coat.  In 3 months, I will put on a gleaming resident’s coat with the freshly printed letters: MD.  Again, I will be at the bottom of another food chain but with many more responsibilities (and longer days to match).  This week I will be giving up some of my blog to this journey.  There will be 4 posts: one for each rewarding and challenging year dedicated to becoming a doctor.  Look for them in the coming days!

Easter Celebrations!

Easter was the first real holiday that Tony and I spent together.  Over Easter dinner, Tony met my grandparents for the first time in 2005.  He settled so easily into conversations with all of the family members, as if he had been coming over for years.  That Easter, I also happened to be fostering and bottle-feeding 3 young puppies.  Watching that handsome man juggle three adorable puppies melted my heart.  I remember, by the end of the day, I got the feeling that I would never be bringing another boyfriend home to meet the parents.  No one else would ever fit in so perfectly with my family. 

As a holiday dedicated to new beginnings through the resurrection of Jesus Christ, it was fitting again to see this Easter as one of “firsts.”  It was the first Easter in my life spent outside of Albion, as we celebrated at my parent’s house in Ithaca.  Margie, Paul’s girlfriend, joined us for the first time and quickly won over the whole family.  And, our furbaby Butters enjoyed his introduction to Easter as well.  On the difficult side, it was the first holiday spent together since the loss of my Grandmom Lucy earlier this year.  This really would have been an Easter she would have enjoyed.

As always, Mom cooked the food to perfection and the decorations were gorgeous.  The large ham and excellent quiches kept people coming back for seconds and thirds.  

It was such a blessing to gather with family and friends, enjoying wine, watching movies, and sharing stories.   

Paul and Margie surprised the family Easter morning with some great treats and special cards.  And, somewhere in the excitement of Easter, “Cookies and Cream Bunny” lost his head.

Butters was also very satisfied with his new “muscle shirt.”  Jessica, Margie’s daughter, picked it out (we all missed you, Jess, but look forward to seeing you at graduation!!).  It looked great on the little guy, and he happily modeled it around the house!  

I know this coming year will certainly be filled with many more “firsts” when Tony and I make our big move to Texas.  But, we will continue to look forward to special moments like these when we can come home to family and friends.  

A little light on the Easter decorations

Between the distractions of medical school and enjoying March break, Easter kind of snuck up on Tony and I.  It really didn’t seem like we had eaten enough Friday fish fries.  Hadn’t it just been Ash Wednesday?  And, somehow we made it almost all the way through March without purchasing a single bag of candy (something that never happens)!  However, last week we got our act together and finally bought bags of our Easter favorites: Reese’s mini eggs and Starburst jellybeans.

With our move to San Antonio right around the corner, we have promised ourselves to stay away from buying holiday decorations.  Tony and I have been working through the difficult task of sorting through all of the odds and ends.  It is amazing what accumulates in just a few short years.  We have already taken 6 bags of holiday items to the Salvation Army. Most of these items were long forgotten in the deep corners of closets.  So, we saved some money and storage space by using items we already had around the house to get a little Easter cheer going.

Butters also offered to help us out with the spring-cleaning by eating all of the Easter candy.  Much to his disappointment… no chocolate (or jellybeans) for little doggies

Butters enjoys spring

When Butters first came home with us from the breeder, we were reluctant to give him too much free-reign of the backyard.  With all of the rain (instead of snow) that winter brought to Western NY, the yard turned into a giant mud pit.  Daily baths for a puppy got old really quickly!  He also felt the need to help us clean up all of the rabbit droppings that once covered the area.  Our yard used to be the only safe haven in the neighborhood for wild rabbits.  Luckily, Butters has made sure that no rabbit will ever step foot in our yard again!

Now that the yard has dried up a bit (and the droppings seemed to have disappeared), Butters has discovered that he really LOVES the backyard.  When I am trying to find him, there usually is a good chance that he will be watching for birds through the sliding door.

I love to watch him when he first heads out.  As soon as I open the door, he runs into the backyard like a wild-man!  

Recently, he has seemed to taken an interest in eating dandelions.  I swear, this dog really would eat anything!

And, of course, he sulks a little when he has to come back in...

... at least until he gets his treat :)