Playing Catch-Up

Sorry for the lapse in writing! It’s been a busy month --- the end of pediatrics in Iowa City and the beginning of OB/GYN at Broadlawns Medical Center in Des Moines. I’ve caught one baby by myself (There was barely time for the gown and gloves!) and scrubbed in for a few C-sections. I made a very quick trip to DC three weekends ago for an AMSA board meeting and have been planning year four and international electives. So, pull up a chair, and grab a cup of coffee --- this may be a long one!

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It seems that just when I finally get the hang of things on one clinical rotation, it’s time to cram for the test and move on to the next one. The first week of any rotation is a bit rough. You’re getting used to new staff physicians, new presentation styles, new computer systems, new patient demographics, and a new cafeteria. Last week was no exception.

After packing my van in subzero temperatures the night before following the end of our umpteenth storm of the season, I attempted an early morning drive to Des Moines on I-80 last Monday to make it to Broadlawns in time for my orientation. No such luck. I eventually made it to the interstate and traveled west at no more than 15 – 20 mph, slipping and sliding on a virtual snow-and-ice washboard and passing a 16-car pile-up just west of the Cedar Rapids exchange. After fifteen miles in 45 minutes, I turned around and hobbled home … and ended up staying put for two days until the Iowa DOT declared I-80 safe for travel. Naturally, my preceptor was not entirely pleased with me when I arrived on Wednesday midday and was rather gruff and direct --- turns out that is his normal mode of operation (which, in fact, is a very refreshing and quick way to learn!). Strike number one.

The following day, I saw my first “new OB” patient all by my lonesome. At our particular clinic, we have a green four-page intake form to complete, a yellow paper for the patients to sign, a risk factor grid to fill out, a white half-slip of paper for follow-up appointments, and an orange appointment reminder card to give … along with a carbon copy billing sheet to code. The number and color of all these forms is a bit daunting. My initial patient was Spanish-speaking only, and I translated without problems. When I finished, I returned to our OB/GYN workroom to find my staff and present the patient. I fiddled with the chart until I found the green sheet with the most pertinent data, and no sooner did I start to talk, did he stop me and have me restart twice to share the information in his preferred order. I managed to get to the end and thought I did a pretty decent job. “How about smoking or alcohol use?” he asked.

When I didn’t respond fast enough, he flipped over the second green sheet to its backside … all the social history questions, including drug use, safety in the home, and history of mental disorders (all essential to establish as part of an initial OB visit), were blank. Absolutely blank … I forgot to turn the page over and answer any of the questions! “You didn’t do this,” he said pointedly. “Get back in there, and finish the job.” Can anyone say strike number two?

The next day, I sat in our workroom between patients and got to know the nurses and fellow DMU medical student. At one point in the conversation, I looked up at the white board and noticed an interesting “B” mnemonic, a list with such words as belly, breast, bladder, bowels, baby, blues, boinking, bleeding, bottom, and birth control. This extensive list describes what needs to be discussed at the six-week postpartum visit. I surveyed the words and noticed one term unfamiliar to me. Curious, I asked aloud, “Boinking. What’s boinking?” I do believe I could have heard a pin drop … the nurse and nursing student looked at each other and giggled, and the medical student turned toward me quizzically. I very quickly had a good idea for what boinking meant. Apparently, in my nearly twenty-nine years, I had somehow missed that boinking is a code word for sex. Unbelievable … it’s sure a good thing I can laugh at myself! If the list had included the much cruder “banging,” I would have had no difficulties whatsoever … think of all the slang out there that serves as a stand-in for the simple three-letter, one-syllable word! Thank God my attending was not present when I made that indiscretion, but word soon got around to him that his new student didn’t know what it meant to boink. Ugh. Strike number three --- I’m out and want to go crawl under a rock!

(Fortunately, week number two fared much better!)

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It’s always easy to tell test weeks around my house. I slice time from other activities (aka cleaning) and focus on reviewing, practice questions, and memorizing. Everything else gets pushed to the wayside --- clothes get dropped where they fall; dishes get stacked on the counter; papers are strewn everywhere in the office. Such was the case two weeks ago when I was studying for my pediatrics exam. It’s certainly a good thing I live by myself --- there was no one around to complain about the mess (or the strange smell in the kitchen) besides me.

At one point in my study marathon, I took a brief e-mail break and was surprised to see a message entitled “The Events of This Morning” from University of Iowa President Sally Mason. I opened it only to read that yet another campus shooting had taken place in the neighboring state’s Northern Illinois University. University and academic officials had virtually no warning, and little about the perpetrator had caused suspicion. He stepped out from behind a black stage curtain and opened fire on an introductory oceanic sciences class. Students ran for the door and darted under desks. Can you even imagine? I immediately recalled the horror last year at Virginia Tech. I lived in neighboring DC (former home to the metro-area white van sniper attacks that gunned down people filling their cars with gas), and for a few days after that massacre, I looked over my shoulder and peered at balconies on the street above me more often than usual, overly vigilant for any unusual sign. Any one of us could be the next victim of wanton violence.

These days we live in a world where we can’t be students of higher learning without the risk of flying bullets. We can’t go shopping at malls during the holiday season for fear of not leaving alive. There is 9-11 and all its sequelae, crimes against women, brutality at our borders, the war in Iraq, tribal warfare in Kenya, suicide bombers in the Middle East, high tension surrounding Kosovo’s new-found independence, human trafficking, and the list goes on. It’s often a coincidental story of being in the wrong place at the wrong time. But staying close to home is not the answer --- you could get flooded out, frozen in the snow, or flattened by a tornado. Some days, I feel like I’m waiting for the other shoe to drop. Collectively, we are capable of doing good deeds, but with the summation of all these brutal tragedies, it’s hard to see what is right, what is true, and what is possible. The current state of affairs is enough to make even this eternal optimist blue.

I certainly hope that the families of those killed at Northern Illinois, at Virginia Tech, at Columbine, at the University of Iowa, and the many others have support systems in place and are doing as well as can be expected. Reasoning through life’s events is never easy but especially not so when they are so senseless, empty, and unfathomable. College students learning in class are not supposed to die. There is very little safe ground left.

It’s frustrating that it takes the bad news in our lives to put things in perspective. I get unnecessarily stressed and grouchy before exams and wish them away, but at least I’m still alive to take the test … and to relax with my friends afterward while shopping at the local mall.

Others are not quite so fortunate.