Reason #1 I joined the military: Travel!
One of the first times I contemplated the military scholarship for med school was during my first year at BYU. I took a "premed prep" class that basically introduced various aspects of medicine and how to go about preparing for medical school. It was a 7 AM class and I honestly slept through most lectures. They had all kinds of specialists come tell us about their careers. One morning they invited a doctor who spent 20+ years in the military. He had pictures from all over the world, not just traveling but actually practicing medicine! The military offers all kinds of opportunities to practice international medicine and I can't wait to see more of the country and hopefully other countries as well.

The other day Ike would not be consoled. He was trying desperately to get something in the kitchen and Leisy and I had no idea what he wanted. Leisy insists I'm better at translating Ike's jibber-jabber, but together we couldn't make sense of his words. His words quickly melted into frustrated screaming and tears so I picked him up and had him show me what he was after. He opened the freezer and rummaged in the crowded top shelf until he found one of these:I had no idea we even had any of these left - they were from last summer. When I opened it the thing was covered in ice frost and looked disgusting, but he started laughing through tears and declared "popsicle - Yay!" which sounded NOTHING like "popsicle".

The red, white, and blue reminded me about posting the reasons I joined the military. Maybe my desire to serve the country started from a young age when my parents bought me this:
Does anybody else remember this book and tape?!? I thought of this the other day and how much I loved listening to it. I wish I still had it so I could start indoctrinating Zeb and Ike! I really have tried to find some of these songs online but haven't had much success. Anybody out there have access to these songs?

My little helpers

These boys want to help me do everything - especially when I make cookies. They are so interested in what I'm doing from the second I walk in the door. They are so much fun right now. They can be so demanding and so frustrating at times but they really are the best little kids in the world. They are also the best of friends. Tonight Zeb said our family prayer and Ike knelt next to him with his arms folded and eyes squeezed shut and repeated everything that Zeb said - it was adorable. I love these little cookie monsters.

It has been much harder to stay focused on school now that I have matched and found a house. It feels like my mind is already in Dayton at times. My fellow classmates still haven't found out where they will be going - they won't find out until March 17!! Maybe the stress of not knowing keeps them working hard on their rotations. I think it wouldn't be so bad for me except I've used up all of my Pediatric time for 4th year and have to find adult rotations that A) haven't filled up and B) are interesting to me. So this is how I've spent my time since January:

PM&R - Physical Medicine and Rehabilitation
I wasn't able to get a Neurology rotation so I thought I would see a lot of neurological disorders through this rotation. I saw several people who were debilitated by strokes, multiple sclerosis and spinal cord injuries who needed coordinated care with a doctor and their therapists (physical, occupational, speech). We took care of their medical needs to make sure they were healthy enough for therapy. I also saw many patients post orthopedic surgery who were recovering. I saw A LOT of chronic back pain and people trying to manage their lives while taking narcotics - I think it will be difficult to judge who deserves narcotics and who doesn't. Luckily chronic pain in pediatrics is not as common as it was during this rotation!

Ophthalmology
I spent two weeks with the ophthalmologists (12 at the office I worked in) learning about all kinds of different eye disorders. We really don't get that much exposure to eyes during medical school, even though eye disorders are fair game on all of our board tests. I spent several days during this rotation with a pediatric ophthalmologist studying various conditions like strabismus, amblyopia, nasolacrimal duct obstruction and others. I even spent a morning in the NICU evaluating the preemies for retinopathy of prematurity. I finally understood why my sister worked with an eye doctor and a plastic surgeon in her office; plastic surgery is a fellowship within ophthalmology that specializes in surgeries from the neck up.

Forensic Pathology
I spent a few weeks in the Coroner's office learning about death. Every morning was the parade of dead bodies to autopsy and determine their cause of death. I saw drug overdoses, victims of car accidents, suicides, even a murder. The murder investigation was just like you see in movies! The detectives were there with cameras, fingerprinting kits and DNA sampling. The victim was shot in the head and put in the trunk of his own car. He wasn't discovered for several days - luckily it has been super cold and his body was frozen. I can only imagine how a dead body stuffed in a trunk for several days in the hot, humid, mid-western summer would smell. Blech! I even saw an autopsy of a three year old. This was so difficult to watch. I thought of Zeb the entire time. This little boy was sick at home, climbed into bed early in the morning with his dad, and was found unresponsive 30 minutes later. I couldn't believe how teeny tiny and pristine all of his organs were. Holding his little heart in my hands was surreal. This rotation offered a lot to learn about general anatomy, pathology and forensics. I loved it - but couldn't do it for a living.

I figured if I didn't get the rotations I really wanted, and I can't do any more pediatric rotations, then I'm going to look for rotations with easy hours. I have really enjoyed sleeping in, long lunch breaks and early afternoons (or afternoons completely off)! I have spent lots of time with Leisy and the kids, spent some extra hours in the gym, and have read for leisure for the first time in years. I'm really enjoying 4th year! I realize I will have quite the rude awakening when residency starts - but at least the crazy hours will be pediatrics!!

It's been over a month since we found out I will be doing my residency in Dayton, Ohio. We really couldn't be happier about the results. I loved everything about the program: the location, I liked everyone I had a chance to work with, and I especially love the fact I will get to work at a children's hospital.I also liked the program in San Antonio but they only had a base hospital with a children's floor and didn't have an entire hospital dedicated exclusively to pediatrics. I also don't think Leisy would have faired too well in the hot San Antonio summers.

I had heard all kinds of horror stories about the military and how it was a mistake to join. People told me I would be forced into a residency that they wanted me to do and I wouldn't have a choice in the matter. Other people warned the only way I could get my top choice of residency was to complete several GMO (general medical officer) years, which would ultimately delay and discourage me from other specialties. I'm happy to announce this wasn't at all true for me and it wasn't true for the other students in my class with the military scholarship. There are 6 other HPSP (Health Professional Scholarship Program) recipients in my class and every one of them got their top pick for residency. They matched into really competitive specialties too: Radiology, General Surgery (in Hawaii), Orthopedic surgery (x2), OB/GYN, and Family med. Last year the two Air Force students got their top picks as well. One went into OB/GYN and is in Dayton now - he actually turned down an interview at Yale because he loved the program at Wright-Patt so much! The other student last year didn't want to do a military residency and was able to get his top pick in general surgery outside of the military. So, I don't really buy into the "you're-ruining-your-chance-to-do-what-you-want-because-you-joined-the-military" hullabaloo. I'm really happy with my decision to join the military. I'm going to have wonderful training in peds, I'm looking forward to serving the country by taking care of service men and women's children, and it's really really nice to finish med school with zero debt! There are several other reasons for joining that maybe I'll blog about someday.

I've been reading this book Leisy got me for Christmas about a pediatric surgeon in the Air Force. He was deployed to Iraq on two different occasions and his experiences are fascinating. It would be so hard to be away from family for so long, but such a neat opportunity to take care of children who have been so devastated by war. It's a great read to find out what a Dr. might do in a war zone or during a deployment.

Heme/Onc

Today I started the second week of adult outpatient Hematology/Oncology. I have a normal 9-5ish schedule and see patients in the clinic for visits regarding their cancer or blood disorders. I have seen many things from breast cancer to colon cancer, polycythemia to pancytopenia, anemias, leukemias, myelomas and lymphomas. I have spent some time in the hospital's infusion center with patients getting chemotherapy treatments and time with the pathologists looking at certain cancers under the microscope.

It has been an interesting rotation so far and I have enjoyed reviewing all these different disorders. However, I totally miss pediatrics. Adults just aren't as patient and fun to work with. Most adults don't expect you to make them laugh and giggle when you listen to their heart and lungs. A lot of them roll their eyes and ask when the actual doctor is going to be in. One very interesting thing about this rotation is seeing the various ways people deal with difficult diagnoses. I have seen patients who are so optimistic and so prepared to do whatever is necessary to defeat their disease. They are motivated and inspirational. I have seen other people who succumb to the disease and act defeated before they even have a complete diagnosis.

The physician is an integral part of these people's lives. I was present when a physician encouraged her patient to mend her broken family so she could have support during her illness. I have seen another physician lecture his patient about putting his life in order so he wouldn't lose his health benefits. These are very complex diseases and affect more than just the body - they affect the patient's entire life. It is exciting to realize how much trust and confidence these patients give to their doctor. It is humbling when patients open up and share the most intimate and private parts of their lives in order to fix their problems.

In other news - we finally got the snow we have been wishing for!! I love the snow and am so excited for Christmas. The snow makes it feel like Christmas is actually on it's way. This week is match week for me!! I should know where I will be doing residency by the end of this week. I'm so anxious it's all I can think about. Luckily I have a normal work schedule that allows me to get to the gym and deal with my anxiety that way.

Can't say no

I finally finished my crazy 3 month block of Pediatrics. One month in Texas, one in Dayton and one here in Toledo. It was exhausting and I worked some fairly long hours. I did managed to find time for fun on the days I was off. I knew I was going to need a break after those three months and I can't believe that that break is over! My two weeks of "flex" time allowed me to recuperate and get some things in order. However, I got roped into presenting an "interesting case" that I saw earlier this month. The Pt was only on my service for one day and decompensated quickly. He spent 2 days in the PICU (different service) and when I found out I would be presenting his case he was being transferred to the University of Michigan for some intense therapy. He survived (I thought he would die for sure) and now I have been busy trying to pull information from the PICU, Michigan and his Primary Care Provider. I finally pulled it all together this morning (I present tomorrow) and I no longer care how this presentation turns out for several reasons: He never had an actual diagnosis, I'm totally done with the rotation, the presentation will (should) not reflect on my evaluations, and the Military has already convened and my residency fate is already decided!! I should find out in 2 weeks where I will go. Needless to say, this presentation tomorrow should not affect me. It just has taken up a lot of my flex time to put together (grrrr). I need to learn how to say "no" to attendings!! I hope to get a good letter of recommendation from her - I don't need it, but maybe I can keep it in my journal or something.