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Dear all,

Please put your hands together for the FINAL SUMUN OF THIRD YEAR!

*applause*

It was a pretty intense last week of third year, to be honest. And now it’s over, and I can put all my heart into studying for Step 2. But before that, let’s get on with the show!

On last Sunday’s shift, I was ON FIRE! I was taking histories and doing physicals like a boss, and even getting the diagnoses right! Felt pretty damn good that day. I wonder what I did differently, haha. But there was some guy who I interviewed for back pain. He was resting comfortably on his stretcher until I walked over to talk to him, then he got off, leaned against the stretcher, and started howling in pain.

“Too many questions!” he yelled before I could even ask him if anything he did made the pain better or worse. I told him that in order for me to help him I needed more information, so he kind of settled down for a while before almost twerking against the wall. Er, not really sure that will help your back, sir…

I left to get my resident, portrayed the story, and when we returned he was resting comfortably again until my resident made his presence known. Ah well.

I had Monday off, so I just studied. Tuesday was a pretty unremarkable shift. Wednesday was my nursing shift, so I got to put IVs in people. Mwahahaha.

Thursday I also had off for studying, but WHOA I GOT THE GOLD HUMANISM AWARD!

H-HOW DID THAT HAPPEN?

DOES THAT MEAN PEOPLE ACTUALLY THINK I’M A DECENT PERSON?

WHAT CHUMPS!

Note, the Gold Humanism Honor Society is for students, residents, and physicians who “demonstrate excellence in clinical care, leadership, compassion, and dedication to service.”

I’m, like, one of those. Maybe two depending on how much sleep I got that day and if I ate breakfast.

But to my classmates who voted for me, I hope that I can live up to your expectations in fourth year, residency, and attendingship (that’s not a word, it should be a word). Unfortunately, I won’t be able to attend the ceremony because I’ll be taking my Step 2 CS exam in Philadelphia. But maybe that’s for the better. I’m 75% sure I would walk on stage, accept my award, then take fistfuls of chocolate out of my pockets, and throw them into the audience, screaming, “CANDY, MUTHAFUCKAS!”

Pretty sure the president wouldn’t approve of that, haha.

Friday was our “end of clerkship meeting”, where I officially became ACLS certified, thanks to a piece of paper that I stick into my lanyard. We also ran through a simulation case…and our patient died of pulseless electrical activity secondary to hypokalemia. (Note: get your i-STATs early! We could have saved him!)

I showed up to my graveyard shift from midnight to Saturday morning. And on the literal last day of third year, I had my first patient die on me.

She was a trauma after a T-bone motor vehicle crash, 60-something years old but looking younger. She was talking normally on arrival, complaining only of leg pain. As with all traumas, I just hung in the back because there were already like a dozen people all doing various things. And even though I was newly ACLS certified, I left all the hard work to my residents and attendings who saw this on a daily basis.

Suddenly, the patient stopped answering questions during the secondary survey. The person at the head of the bed announced, “she’s not breathing.” Another person at her side said, “there’s no pulse.” Her EKG showed supraventricular tachycardia. Then the real trauma began.

Nurses were lined up at the bedside to do chest compressions. She already had an IV in place, so all that was left was to push epinephrine and amiodarone to slow the rhythm down enough to see what was happening. Since it was pulseless electrical activity, there was no need to shock her, but defibrillator pads were placed as a precaution. She was intubated, i-STATs were drawn, fluids were given.

Five minutes passed. Then ten. Then twenty.

The pulses never returned.

Her rhythm slowly descended into asystole.

She was pronounced dead after 23 minutes of chest compressions.

Then the nurses covered the body to be heeled to the Medical Examiner’s room. Then the attendings and residents left. I followed, mind spinning a little.

It was a bit surreal watching them get back to work. One minute, the attending had been shouting orders for more epinephrine or for compressions to stop to reassess the pulse before continuing. The next minute, she was stomping around, pretending to be a velociraptor. (Note: She’s a strong 10 on the Lesbiannette scale. Also, the Lesbiannette scale only has 10s.) My resident, too, had been managing airway just five minutes ago, and was now writing notes so patients could be discharged. I thinks she noticed I was a bit out of it, though, since she asked if I was all right and told me to take an early morning snack if I needed to. I declined, since it was like 3 AM. I went back to seeing patients.

Like the Chinese citizen who was here visiting his friend, and got what we thought was classic appendicitis, but turned out to be nephrolithiasis at the utero-pelvic junction. (It was kind of funny, because the patient didn’t speak English and all the translation was done through a friend, who asked me, “Do you speak Chinese?” and I’m like, “hahahahahahahaha no.” Then when the resident came in, she was like, “Can you understand them?” and I’m like, “hahahahahahaha still no.”

When 7:30 rolled around, I was dismissed, and I walked back to my apartment in the early morning light…just to sleep for 4 or 5 hours and get ready for my last shift from 4 to midnight.

This one was on the peds side! Or I should say the orthopedic clinic, because LITERALLY 2/3 OF THE KIDS HAD SOME TYPE OF BROKEN BONE.

SERIOUSLY WHAT ARE YOU DOING PLAYING OUTSIDE IN THE RAIN.

RAINY DAYS ARE FOR BOOKS AND VIDEO GAMES.

THAT’S HOW YOU GET INTO MEDICAL SCHOOL.

IT WORKED FOR ME.

One poor kid came in after breaking his tibia AND fibula at Skyzone, an indoor trampoline park…and it was his birthday.

HAPPY BIRTHDAY, KID! HERE’S YOUR ORANGE CAST!

According to my attending, Skyzone is to blame for many orthopedic injuries…but they aren’t held liable. Typical.

Anyway, I was relieved before midnight, so I tottered back home and slept. Today I’ve got some studying to do, then I’m going to an Escape the Estate event with some friends! Time to put those survival manga abilities to the test!

I’m kind of surprised, but I’m not as upset about the patient not being able to be revived as I thought I would be. It’s not that I’m heartless, at least I hope it isn’t. but to stay in this practice and retain my humanity, I can’t let the suffering of patients affect what I do. But when I become a psychiatrist, will I be all right if one of my patients commits suicide? If I make sure they’re taking their medications properly, and make sure that they don’t want to hurt themselves during our appointments…what would I do if they went through with it in the end?

I’m scared that will happen. Actually, I think that’s the scariest thing that could happen. Legally, I wouldn’t be held responsible as long as I followed protocol. But emotionally, I feel like I would carry that burden even more than if I couldn’t save a patient during a code, or if a patient bled out during surgery, or if antibiotics couldn’t clear a fatal pneumonia.

I remember an episode of Scrubs where Dr. Cox wasn’t able to save one of his patients, who he was friends with. He started flipping tables and crying. When I watched that episode, I didn’t quite understand his emotions. He was still just a TV character to me. But now that I’ve grown a little, I’m beginning to grasp what it actually means to be a doctor. Sometimes you’re not just trying saving a patient’s life, or even the family’s lives. You’re also trying to save your own.

So! On that dep note, it’s time to sign off on third year. Dear readers who have come to read my blog religiously, those who only visit when schedules allow downtime, and even if you just scroll to the end to read the Sarcastic Quote of the Week, I thank you from the bottom of my heart. You have no idea how happy it makes me to hear that someone reads my blog, or when someone texts me about what I wrote about. I’m so glad that I could share this experience with others. I’ve definitely grown a lot since I started on this third year journey. I might just read it all from the beginning, to re-live the experience. (Hahahaha, though seriously, probably not.)

Will I continue this blog after I take Step 2 on June 13th, and start fourth year? Maybe, maybe not. I’ll be doing acting internships with more responsibilities, but it’s just going to be the same thing that I’ve written before, just with different illnesses and a more mature outlook. If anything, I’ll write at the end of each four-week stint. But I guess we’ll see what I feel like, haha. If anything, I’ll be able to focus on my fantasy novels more, and will possibly post those. So until then, everyone stay healthy, love each other, and keep running towards your dreams! In the words of (the infamous?) Patrick Lee, “YOLO.”

Most Sincerely,
Annette Liem
Fulltime student, lifetime daydreamer

~Sarcastic Quote of the Week~
“We fooled them all!” – John Pyun, fellow Gold Humanism Award winner

P.S. The song I'm referencing in the title is "Connecting" by Halyosy. You can find an English cover here: https://www.youtube.com/watch?v=YJNeHWekXeU I won't lie, this song has made me calm when things are too stressful for me. I'm glad for all the connections I've made, and for all the ones to come. Let's not lose the threads that keep us together!