how firm thy friendship

As I write this, both the medical school hooding ceremony and the University Commencement have passed. I am now, officially, Dr. Amy Manning, MD. Being one of the newly minted doctors of the Class of 2013 and being a member of this amazing class at all are both wonderful feelings. The last four years have been incredible, and they have flown by. I never imagined that medical school would be as much fun as it was. Moving here from the University of Michigan and Ann Arbor, I never imagined that I'd love Ohio State and Columbus as much as I do. There, I said it: I love Ohio State. It's going to be hard to leave this place behind.

The last four years have brought with them the many hours of hard work that I expected they would, but they have also brought some unexpectedly perfect moments and experiences. The patient with heart failure whose lungs I asked to listen to, who later thanked me for listening to her (and I don't think she meant to her breath sounds). The jokes shared during a 4:30am walk to the hospital with a friend. The four foreign countries visited, some for vacation, some for medical service and learning, but all of which were fun and breathtaking in their own ways. The random and highly generous woman who gave me and four friends a ride to yesterday's commencement when we were running late (I tell you, hitchhiking is much easier in a cap and gown). And the sense of community and purpose that pervaded it all.

...

On Sunday, May 5th, OSU held its Spring Commencement. I hadn't planned on going originally; the hooding ceremony is the one that really counts for medical students, and the one my family came to share with me. But since my schedule is recently very open (read: I'm bored) and I still had the costume, I decided to join some friends on the field at Ohio Stadium for the conferral of our actual degrees and for President Obama's graduation speech.

I'll never truly understand the level of hype around having the President speak at your graduation ceremony. I also attended the University of Michigan graduation when he gave the 2010 address, and I wasn't drinking the kool-aid then either. Sure, he's a charismatic speaker and an international celebrity, but the overall effect of his speech left me feeling nothing. Packed with buzzwords ("citizenship" and "patriotism") and thinly-veiled political partisanship, Obama said little of actual substance. You can watch the speech below, but at nearly a half hour in length, I'd say Obama overstayed his welcome.

Not to make this about any rivalry (because obviously I have very little shit to give about the Michigan-OSU rivalry; I've got two horses in that race), but contrast this to the address given at Michigan this Saturday by Twitter CEO Dick Costolo. Costolo is a much smaller "name", but not only does he have a real connection to the university, having graduated in 1985 with a degree in computer science, Costolo has a real story to tell. His address is both humorous and human, and echoes the 2005 Stanford address given by Steve Jobs. Be the judge yourself, but I'd take Costolo's over Obama's any day.

everything is beautiful and nothing hurts

I MATCHED!!! Match Day 2013 was Friday, and, surrounded by family and friends, I found out I'll be spending the next 5 years in Cincinnati training to become an otolaryngologist. Which is awesome, and I couldn't be more thrilled. It's the culmination of years of hard work, blood, sweat, tears, and of course lots of $$$. The entire last year (and indeed really last four) have been pointing toward this day, this achievement... my dreams are coming true. Graduation seems like a formality now that I know I have a concrete plan ahead of me, now that I know I'll get to train in my chosen specialty. The work of medical school is almost 100% done; now is the time to celebrate.

Why then, do I keep feeling an overwhelming urge to cry? Maybe it's the inevitable fallout of so much anticipation, the kind of let-down I felt following each big skating competition. Perhaps, though, it's in the realization that soon, very soon, the people I have come to know and love so much over the past four years will scatter, dispersed across the continent to pursue their futures, but never again to truly be the same cohesive unit that we have become. These people were strangers at the beginning of all of this, but as we've laughed, complained, studied, traveled, partied, lived  and loved together, we've become a family. I guess we've always known it was coming to this. But at the beginning, four years sounds interminable, and you never really think about how many mixed feelings you'll have when the moment actually arrives. Starting over in a new place is hard, and right now a big part of me just wants to curl up in a ball and try to hang on to all of the amazingness that the last four years have been.

I know I felt the same way about leaving my undergrad "home" when I began med school. In a few short months, that beginning will come to an end, and another will start. I'm scared. It'll be the hardest thing yet. Am I good enough? I know, though, in my innermost self that I am, and I will be.

Happy is what happens when all your dreams come true, isn't it?

Lost in Lima!

and I think I almost died. Well, perhaps not, but there was a certain amount of panic. I went for a morning run around Miraflores yesterday. I left around 6:30, an hour before we had to be ready to leave for the clinic where the the otology course is happening, thinking I'd run for a half hour and then have plenty of time for a long overdue shower and breakfast before we would leave. It didn't go as planned - I got a little lost (luckily I don't think I left the district, but some of it did look pretty shady). I finally found my way back to the apartment at 7:25. I think I ran at least 6 or so miles, but I really can't be sure because I don't have any idea where I went. All I know is that upon my return, I promptly ran upstairs and changed clothes, splashed water on my face, and grabbed a granola bar and an apple for breakfast and ran out the door. I was still sweating buckets and I didn't have a chance to brush my teeth (ewww). Moments like these make me glad I never saw the movie Taken. I guess any potential kidnappers would have to catch me first, and the adrenaline from the panic made me faster I think.

I told my mom about it later. She was wonderfully unconcerned.

Peru (real) day 1

Just finishing up my first real day here in Lima. I arrived yesterday afternoon and pretty much just spent the afternoon settling in, after a rather terrifying ride from the airport. Seriously, I think the lanes painted on the roads are more suggestions than actual rules. And who needs stop signs when you've got a horn on your car?? As evidenced from what little I've seen of it so far, Lima is a sprawling metropolis, and an interesting mix of modern city and slum. Some of the older buildings harken back to the Spanish style, while others are high-rises, but the majority are about 4 stories maximum, often painted in many colors, most covered in dirt and graffiti. The district where I'm staying, Miraflores, is the nicest I've seen so far, but I haven't had the time or the guts to go for a run yet (and im feeling it haha). Ill probably do it next time I'm free in the middle of the day.

Today was the first day I've been to the hospital, Dos de Mayo. It doesn't look like much from the street where the main entrance is, just a blue facade about 2 stories high, but inside it was all hustle and bustle and apparently it's a 500-bed hospital. There are courtyards connecting the different areas, and the wards are open-air. Like Civil War-style. We did 3 ear surgeries today, and the first two only used LOCAL ANESTHESIA. For actual surgery. Mind = blown. It worked surprisingly well, except for when the patient would move a little, and then they'd get yelled at ("no moviendo!" or something like that). The time between cases was precisely equal to the amount of time it takes to wheel the first patient out and the next one in. Operating rooms run a heck of a lot faster without an hour of room turnover time. Mind = blown again. I'm not sure how that jives with the whole sterility issue, but hey, things got wiped down with alcohol puro (mmm... Smells like undergrad). At least I know I wiped down the microscope (they don't have those complicated plastic drape-y thing specifically for the scope here. You may know it as the one the med student gets warned on penalty of death not to touch). I also mixed said local anesthetic (9 parts lidocaine to one part epi. Hope I did it right). Scrub gowns are made of heavy cloth instead of disposable paper and are sweltering, but I did get to close on the last case of the day, so hooray. We also decided the last patient was likely Turners Syndrome, as she was approximately 3'11" and had what looked like a shield chest to me. The pathology in the cases here is so much more advanced than anything I've seen so far in the states because there isn't access to regular ENT surgery for so many people. Sad stuff.

After the day of operating (which ends earlier without room turnover time) we stopped at a bank because Dr. Wagner wanted to close out his Peruvian account. Bill (a really nice 4th year resident from Mayo) and I are sitting in the lobby when these two dudes in line start verbally abusing one another in Spanish and start pushing each other. The security guards (who pack a lot more heat than their counterparts in the states and even wear bullet-proof vests) came to the rescue, but one guy did end up with a bloody nose. Bill decides to document the event via video on his camera and the rent-a-cops with guns come over and start yelling at him to delete the video. Apparently that's not allowed here.

Let's try not to get arrested in a foreign country, Bill.

Peru Day 1: Travel misadventures, or how I ended up in the Dominican Republic illegally(?)…

…because I’m fairly certain I never actually went through customs. But more on that later. The day started off well enough; my 6:20am flight from Columbus to Miami was wonderfully on time. We made one circular, aerial tour of Columbus before banking to the Southeast, at which point I pulled my shade down and dozed off for a few minutes, until the flight attendant brought around the beverage cart and I got some coffee (of which I only spilled a little on myself). We landed in Miami, where the humid, rainy weather immediately made my hair like Monica’s in the episode of Friends where they travel to Barbados for Ross’s conference. I found the gate for my next flight, a connecting flight to Santo Domingo, after walking what seemed like the entire length of the Miami airport (and both gates were in the “D” terminal… I cannot fathom how far away the other terminals were, since I even had to take the skytrain one stop to get between D60 and D23. I proceeded to hunker down for a couple of hours, eat some Second Breakfast, call my mom one last time while still in the States, and do some people watching (airports are possibly the best place for this). I hung up in plenty of time to be ready for boarding, which included almost an hour of “we’ve changed aircraft models and the seats aren’t the same, so everyone has to re-check in” before we never actually boarded the plane. Apparently there was a maintenance issue that couldn’t be resolved (aka the plane was brok’d), and after a long wait, they assigned us a new gate number (back on that skytrain), a new plane, and a new departure time. My layover in Santo Domingo had now shrunk from a comfortable 2 hours, 40 minutes to 50 minutes. Which still should have been fine, provided we took off promptly after boarding, and maybe my luggage would even get there too. We didn’t. Take off promptly I mean. We sat on the tarmac while they transferred all luggage from the first plane to the second, while I furiously sent emails to my contacts in Peru and texts to my mom, alerting them to the issue. Still, there was a chance I would make it: the connecting flight was to take 1 hour, 40 minutes. If that was accurate, I’d have 15 minutes to make my flight to Lima and maybe I’d see my luggage the next day.

When we finally landed in Santo Domingo at 5:05 pm (my flight to Lima scheduled to depart at 5:15), it looked pretty hopeless, but was still worth a try. I tried to get up and out of my seat as quickly as possible. I made it about 6 rows forward before everyone stood up to get all their crap (which I’ll never really understand, since you can’t even stand fully upright, and there’s no chance you’re moving anywhere until the plane starts to clear out, but I digress). I had told the flight attendants about my situation during the flight, and was attempting to make my way forward, when a woman just behind me in a yellow cardigan shouted, “tengo connecion! Scuso!” I turned around. “Lima?” I asked, “me too!” “Tambien?” she returned. “Si!” We miraculously made our way forward, but I didn’t really know where to go once we deboarded, so I followed Yellow Cardigan as we attempted to locate our next gate and ascertain whether the flight had already left. We were directed down to Baggage Claim, where we rushed up to the American Airlines desk and Yellow Cardigan proceeded to explain our situation in rapid Spanish (at this point, I’m wishing I knew a lick of the language more than ever). Then we get the news: the flight has already left. But there is another flight on Copa Airlines leaving in less than an hour for Panama City, where we could catch yet another flight to Lima. We collected our luggage as quickly as possible (and I have no idea how long Yellow Cardigan) was in the states, but she had 3 large bags that could probably have contained several bodies, had she been so inclined). And then customs was in our way (we needed to go to the American Airlines check-in desk to see if we could actually get our flight changed).

I followed Yellow Cardigan as she half-ran, pushing her cart full of luggage containing hopefully-not-bodies as she again said something in Spanish about a connection and that we needed to get through quickly, por favor! And somehow, they let us through. They took our immigration papers they’d handed out on the plane (which I don’t think Yellow Cardigan had actually filled out), and sent us on our way.

Long story, short, we didn’t make that Copa flight. American Airlines put us up in a nearby hotel for the night. Santo Domingo is right on the Caribbean, and during the cab ride to the hotel, I was struck by, other than the palm trees, how much it looked like home in the dark, with the lights of the town lining the bay. Yellow Cardigan woman (whose name was actually Rosa) was really very nice and helpful. I'm glad I ran into her. Now it’s Travel to Peru: Round 2, and I’m back in the Santo Domingo airport typing this (but it won't be posted until later, when I have the internets) about to fly to Panama City and then to Lima, after my second day in a row of a 4am wake up call. Let’s hope the second time’s the charm.

let's hear it for the girls...

Recently I had the honor and pleasure of being inducted into my school's chapter of Alpha Omega Alpha, the national medical academic honor society. It was a goal of mine for a long time, one that I was sometimes scared to say I had in case it just didn't pan out. Being invited to apply and accepted was truly one of the biggest honors I've achieved so far in medical school. For our induction, the other fifteen student inductees in my class and I were invited to attend a nice banquet at the Ohio Union with many of the faculty and higher-ups from the med center. One of the best moments of the night was when Patti Fertel, our beloved but recently retired college of medicine counselor came up to our table to congratulate us. As she left, she added one last piece of congratulations: "and way to go, GIRLS!" This was in reference to the fact that more than half of the inductees were young women. I felt myself smiling and thinking, yeah! Go us!

But later I kept thinking about it. Why shouldn't we expect this of ourselves? Throughout my training so far, I've met and been taught by some very intelligent, inspiring women. It's fantastic that we, as future female doctors, aren't afraid to be smart, driven and competitive. No one would act surprised if the inductees had been mostly men; we need to have high expectations for ourselves as well. Now more than ever, in our current political idiocracy, where pregnancy is somehow being legally defined as beginning two weeks before it conception even occurs we need strong, smart, opinionated female physicians to stand up for our patients, our sex, and for ourselves. Let's give the ultra-conservative religious right something to fear. Let's hear it for the girls.

spring "break"

I said it at the beginning of med school: I don't know for sure what I want to do (I was pretty sure I wanted to be a surgeon, but hey, some people decide they love pediatrics when they thought they hated children... things change), but I was going to base my choice on what I liked the best. Not what someone else thought was the best choice, or where I thought I'd have the best lifestyle or make the most money or have the shortest, easiest training (though some days, this is tempting).

So in that way, my spring break has been affirming, on several fronts. I chose to spend my two-week spring break rotating on ENT (long story, but I'm going to Peru in May and I needed credit for those two weeks. Plus I got the chance to meet the faculty and see what it's all about prior to scheduling for 4th year next week. Win-win?). ENT is a field that has intrigued me since anatomy during med 1, but I hadn't gotten the chance to rotate through it yet. I showed up with my guns loaded, ready to do my best to impress. And I also learned a lot. A) ENTs work hard. And I mean HARD. Especially on the Head & Neck service, where it's not uncommon for days to last from 5:30am until well after midnight. 2) I got a glimpse into the amazing breadth that the field offers; highly varied, highly intellectual (these may be the smartest doctors I've worked with. Do I fit in here?), and highly rewarding. And D) this is what I want to do with my career. This is a field in which I'll find endless intellectual stimulation, it's highly technical in its surgical aspects, but it's got more clinic time than a general surgery practice. Some patients follow up with their ENTs for years as they manage them post-cancer treatment, or follow chronic conditions like Meniere's disease or Neurofibromatosis Type II. It's like the best of both worlds: the performance aspect of surgery with the human aspect of long-term patient-doctor relationships. There are so many niches within the field that I think I could be happy in; I've got lots of good choices here. And, maybe most importantly, the people in the field that I've interacted with are still happy with their choice of career, whether they're in their first year of training or have been in practice for years. Nothing is more disappointing as a med student than having a doctor tell you "whatver you do, don't do what I did." That attitude was nowhere to be seen in these two weeks.

Yes, the residency is 5 years long and is highly demanding (as is getting into a residency in the first place). But as one of my attendings told me last week: don't let something that's going to be hard during the next five years of your life dictate what you choose to do with the next fifty. So for now, I'll learn as much as I can, work as hard as I can, and yes, I'll keep my guns ready.