Sweet, Beautiful Exhaustion

I am entering my fourth week of my internal medicine rotation, and it is everything I was promised (and warned) it would be!

It is a beautiful mess of busyness: early mornings, overnight calls, long hours, sneaking in meals, tons of meetings, lots of teamwork, and a teeny tiny bit of time squeezed in for studying and sleeping. I have 3 real days off in the 6 weeks of this rotation, and each one is mostly taken up with sleeping. However, for a person who always thought I couldn't function without sleep, I am quickly realizing, thankfully, that I CAN! A good five hours can have me set for the day, as long as I don't sit too long or stop moving :) By the weekend, when our days are shorter, I absolutely crash when I get home.

The long hours are totally worth it though, because I have had the time on inpatient internal medicine to really get to know my patients. I get to know them as people, to educate them about what is going on with their bodies and why they are still in the hospital, to comfort them when they are anxious about their conditions or their support systems or they just want to go home, and to know that I am part of a team that is really helping these people. It is a blessing to see sick people become well, to see patients with chronic illnesses learn the best ways to cope with their lifelong experience of a particular disease, and when necessary, to help patients deal with leaving this life behind. Everyday, I am reminded of the great gift of serving people in this very intimate and often scary time of their lives, and I am so thankful for the honor of taking care of them.

During all of the emotional and temporal madness of this rotation, I have also realized again how amazing my husband is. From leaving flowers on the dinner table when I get home from a long day of work to cleaning up the house without even being asked, he is definitely a keeper. I am so thankful for Mikey's patience with my crazy hours and with my sleep-deprived, emotional ramblings when I am home. He is such a wonderful husband and best friend!

Basically, life is good. I am blessed. And I will post another update as time permits!

recovering from The Moment

Ever since I was young, I excelled in school. And it seemed that the more I was praised for being “above average,” the better I got.  As and Bs were great in middle school, but by the end of 8^th grade, only A+’s would do.  In high school, I studied and somehow ended up as the valedictorian of my class of over 600 students.  I never really meant to do that.  I just worked hard.  I enjoyed school.  And it worked out.

In college, I had the same sort of ride.  I wasn’t the kid who never studied and breezed through every subject, but when I worked hard and put my mind to something, I ended up doing well.  And somewhere along the line, it became part of my identity.

I don’t know if it was when friends started asking me for help explaining a difficult concept.  Maybe it was when my parents stopped freaking out when I got straight A’s because it became a sort of “normal” for me.  And I liked doing well.  But as it became more of a WHO I am, not just WHAT I do, it went from a happy outcome of hard work and a love of learning to a real need to do well.  And not just because I wanted to do well, but because I knew it was what people expected.

This fear of letting down the world, in the form of my friends and my family, started to plague me throughout college.  I lived in constant fear of when THE MOMENT would come…the one where my luck ran out and my hard work just wouldn’t cut it.  I kept waiting, expecting, fearing…but I kept doing well.

I graduated with a 4.0 GPA in a Bachelors of Science in Biology from college.  I did well on my MCAT and was accepted on my first application attempt into medical school. I even received a small annual scholarship, which was a huge honor.  During my first year of medical school, I received Honors in nearly all subjects on my exams.  I was elected to a leadership position in student government, and I started to think that maybe THE MOMENT was just a dark cloud in my head.  Maybe that ominous time would never come.

And then…

The second year of medical school arrived.

No matter how much I worked, how many hours I put in, how much I cared and lived and breathed what I was learning, I couldn’t make it make sense.  It never “clicked” like everything always had before.  I was learning in leaps and bounds, sure. But it wasn’t enough. My grades started falling.  I did not make honors on a single exam my entire second year of medical school.

And I was devastated.  I struggled with depression.  I lost touch with numerous friends, as my husband changed jobs and we acquired a new dog, a rescue, on top of all of my anxiety about how to juggle all of the knowledge I was meant to acquire in my second year of medical school.

I was not re-elected to the leadership position I had during my first year of school.  However, I was chosen as the Secretary/Treasurer for an interest group, kind of like a surgery club, for the college of medicine.  I tried to appreciate these minor victories, to be proud of what I was accomplishing with my hard work in class, and to cherish the other positives I had in my life, like my family and my friends and my home.  But the heavens had opened up, and my life was in the middle of a crazy storm of doubt, confusion, and total frustration with THE MOMENT.

I felt like a fraud.  I went to one of the deans of the College of Medicine to ask for advice on how to prepare for boards, and despite all positive signs during my studying, I missed my goal score for USMLE Step 1 by 16 points. Again, devastation.  Again, trying to keep my head above the flood of emotion because all was finally revealed…I am not that special, not that smart, not that capable.  I am not even quite average in this world of high-achieving, career-minded individuals that is Medical School.

WHO AM I NOW?

This is a question that I continue to struggle with as I am entering my clinical years of medical school.

I am no longer the top of my class.

I am not the leader of the pack.

I am adequate.

The doubts that have taken serious root in my soul from my second year of medical school and my acceptable, but not stellar, performance on Step 1 of my medical boards creep up on me whenever I knock on the door to go in and see a patient.  They sneak into the back of my mind while I am studying cases or reading a medical article.  They question whether I am fit to be A PHYSICIAN…the person that people depend on at their weakest, at their lowest points in life, the person that makes the life and death decisions, that yields their knowledge and their skill in order to make the world a better, healthier, safer place.

And somewhere deep within me, the voice of my soul screams out…YES.  It is what I was made to do.  It is in my heartbeat.  It is in the tears that well up when I talk to a patient about their fears and struggles and desires for a better life.  It is in the steady hand when I go to administer a shot or remove stitches from a healing wound.  It is in the smile that lights up my face when I look back on a day spent caring for others, for their bodies, but also for their minds and their souls.

I AM A PHYSICIAN.

And I will fight every uphill battle to make it to my goal.  I will not let fear or doubt or mere adequacy deter me from the life I was made to live. I may not have the most glowing CV or the highest test scores, but I work hard. I have learned so much.  And I care.  I really, truly, deeply care about every person I have the privilege to call my patient.

So even though THE MOMENT still haunts me at times, I can turn the light back on in my spirit by reminding myself of these truths.  I was made to be a doctor. I am capable and knowledgeable.  I am imperfect and still learning. And I have been given the amazing gift of using all that I know, all that I can do, all of my self, to take care of the sick and the injured.

I am blessed.

I am a physician.

NYC, a big anniversary, and the USMLE

Hello all!  I am such a terrible blogger since med school (especially second year!) started, but for friends and family who are still faithful readers of my rare posts, here are some new things going on in the Baur household:

1.  I finished my second year of medical school! Woohoo! I am officially done with my pre-clinical years of medical school.  Which leads to....

2.  A wonderful trip to NYC with my cute mother to celebrate the end of med school classes! We went to see Wicked, explored the Met, and had all other sorts of adventures...it was a wonderful break, post-class and pre-boards.  Which leads to...

3.  I took the first of three steps of of the United States Medical Licensing Examination last week!  After a month of nothing but studying, it felt great to put this giant, important test behind me!  It will be a few weeks before I get the score that could determine what field and what program I am competitive to do a residency program in, but I am proud of the work I put in...now only time will tell! Which leads to...

4.  The day after my board exam, Mikey and I celebrated our FIFTH wedding anniversary with a trip to Myrtle Beach for a few days.  It was great to get away to spend some time, just the two of us.  I must say, I really love that man :) And finally....

5.  I just had the first day of orientation for my clinical years of medical school! Next Monday is my first official day in clinic as part of a patient care team! I cannot believe that I have finally gotten to this point in my medical education, but I am beyond excited (and slightly terrified) of starting this new adventure!

a day in the OR

This week, I spent about 10 hours shadowing one of the amazing doctors from MUSC.  He is an orthopedic oncologist, which is a very unique and rare specialty.  Dr. L specializes in bone tumors, but he works on general orthopedic cases as well.  I chose to shadow him in order to get more experience in another interesting focus of surgery: orthopedics!

I spent 2 hours in the clinic with him and his team on Monday, learning about how they deal with patients and what type of cases they work.  Then, I showed up at the hospital at 6 am on Wednesday to attend the Orthopedics M&M (Morbidity and Mortality) conference, which is where the residents discuss with their attending physicians things that went wrong in various cases and what to do differently next time.  After that, we headed to the OR! I got to observe two surgeries, which took about 6 hours total.

Here are two videos from youtube (preceded by explanation of what the surgery entails) showing surgeries similar to what I observed:

(ps I know a lot of people will find these too graphic, but for those who aren't squeamish about surgeries, these surgeries are super cool!)

1.  Total Hip Replacement (this video is of an anterior approach, and we did a posterior approach...but same idea!)

• Cut through the skin, fascia, fat, and muscles to get down to the joint capsule, which is opened.
• Dislocate the hip and remove the head of the femur (which is the problem...often, it is arthritic)
• Ream (with a thing that looks like a circular cheese grater) into the acetabulum (aka the hip bone, where it articulates with the femur) until you hit bleeding bone (which will help the bone grow into the implant)
• Place an acetabulum prosthetic and plastic liner
• Ream (aka drill) into the femur with increasingly large reamers and then fit the hole in the bone with the correctly sized broach (which is a piece of metal that is the same shape as the prosthetic)
• Place the prosthetic into the femur (this part is called the "stem")
• Then add a false neck and the real femur head prosthetic
• Relocate the hip and take an X-ray to check leg length (want it the same as the other leg!)
• Dislocate the hip, attach the real neck and femur head prosthetics to the prosthetic stem
• Relocate the hip
• Sew the patient up!

2.  Tibial Nail

• Make incisions over the knee, to the side of the knee (slightly lower than other incision), and to the side of the ankle
• Disarticulate the tibia from the femur (aka pop your lower leg bone out of the knee)
• Place a guide pin to make sure you are going through the center of the bone as you ream down (as was done in the hip replacement)
• Hammer nail into place
• Screw nails at side of knee and side of ankle incisions (to ensure stability)
• Place tibia back in place
• Sew the patient up!

TOO COOL!  These surgeries make such a difference in the patients' lives...decreasing pain, increasing mobility and quality of life! Amazing.

weary

That is what I am right now. weary.

With all that life is throwing my way, there are days that I wake up and just feel so weary, so worn-out and worn-down.

When the dogs wake me up early again...
When school is hanging a long list of to-dos over my head...
When the laundry isn't done and the sink is full of dirty dishes and half of the surfaces in our house are covered with junk that has accumulated over the past week...
When my back hurts and my eyes want to close and my mind can't rest...

I am weary.

And I know I am so blessed.  And while that sometimes helps, other times it just makes me more weary...because I don't always feel like life is this huge blessing, but am I allowed to get frustrated with life when I have so much more than so many others? Weary.

This is one of those mornings...a morning when nothing can fully quiet my spirit and all I can do is call on God to help my unbelief.  To give me grace when I am graceless, peace when I am in turmoil, and hope when I am hopeless.

I don't deserve it.  I don't even fully believe it is going to happen.  But He does.  He knows.  He's in control.  And so I say it with my words and in my mind, and I hope that the Truth of His love and rest will somehow penetrate through my overwhelming weariness and into my tired soul.

ISAIAH 40:

28Do you not know?

Have you not heard?

The Lord is the everlasting God,

the Creator of the ends of the earth.

He will not grow tired or weary,

and his understanding no one can fathom.

29He gives strength to the weary

and increases the power of the weak.

30Even youths grow tired and weary,

and young men stumble and fall;

31but those who hope in the Lord

will renew their strength.

They will soar on wings like eagles;

they will run and not grow weary,

they will walk and not be faint.

give the world a reason to dance

Just wanted to share this little pep talk with whoever needs a little encouragement today.

Take the road to awesome!

a new addition

Meet Duchess

We weren't planning on expanding our little family just yet, but when we heard about the sweet girl's story, we couldn't resist the opportunity to have her as a part of our family!  This beautiful dog was abandoned at a rental property, where she had likely been mistreated and neglected for most of her life. She is underweight, has heartworms and an ear infection, and had never had a rabies shot before this week when Mikey took her to the vet.  Other than that, however, she is in incredibly good health, and she is probably the sweetest, most gentle dog I have ever met.  We are so glad to have her as the newest member of our clan!

Me with all three of the dogs :)

Because of Duchess's separation anxiety, we try to leave her out of the crate unless we are gone from the house, which means she has been sleeping in our bed with us.  And so as to not be unfair to Oliver and Berkeley, all five of us have been sharing the bed every night for the past week! At least we have a king-sized bed :)

We are getting Duchess treatment for her heart worms, fixing that ear infection, and feeding her regularly (of course!) to get her weight up to normal...and most importantly, we are loving on her like crazy! She deserves a lot of TLC after all that she has been through!

a new season

I have been the most slack blogger imaginable, but as med school is kicking my tail and taking up all of my time, I just haven't thought to sit down and write out how wonderful, crazy, and fast-paced life has been over the past six months or so!

As I type this, I am on a fifteen minute break between two lectures, one on genetic causes of cardiopulmonary disease and the second on non-pharmacologic cardiac interventions. And I have to say, I am loving it all.

Ok...the lecture started, and I had to run...but I am back now! Break #2 :)

Here are some updates on what is going on in the Baur household:

Mikey is changing jobs (but not careers!)
My wonderful and talented husband had his last day at Northwood Assembly on Christmas Eve.  We are both stepping out into the unknown to plant a church in the North Charleston area inside the I-526 loop with some friends.  AJ Rankin was a youth pastor at Northwood and left about six months ago to begin work on The Hive Church.  Over those six months, Mikey and I prayed about where God wanted us to be, and it became clear that we were meant to join AJ and his wife Alison in planting the Hive Church.  Here is our website, if you are interested in seeing what we are all about!

We are both extremely excited about the path our new church is taking as we start to set up missional communities, groups of people coming together to encourage one another, talk about how we can make an impact for Christ in our city, and just live life together.  We are in the process of raising funding for the church, and services will start in August or September.

In the mean time, Mikey is in search of a job to pay the bills.  He is very involved in meetings and such for the Hive Church, so he needs something with sufficiently flexible hours.  Please pray with us that he finds something quickly that will meet our family's needs.  We are extremely blessed to have loan money to depend on until then.

I started taking dance classes again.
Most of you know that I danced ballet for 10 years, starting from when I was 8.  I absolutely loved it and spent most/all of my "free" time in class, rehearsal, or stretching on my living room floor.  However, half-way through my senior year of high school, I was diagnosed with Iliotibial Band Syndrome (IT band syndrome), which means that the tissue stretching from my hip to my knee got really tight and was causing significant knee and hip pain, exacerbated by dancing.  I did 6 months of physical therapy, but dancing was still difficult, as it would cause a flare up of knee pain.  So with marriage and school soon taking up most of my time, I ended up taking about 5 years off of dance, the whole time desperately missing it.

A couple of weeks ago, a friend mentioned a studio really close to MUSC that has dance classes for adults, and I checked it out.  I am now officially registered for two classes a week.  I am not pushing myself to do ballet, although I would love to, because it is harder on my knees, but I am so happy to be taking a modern and a contemporary class.  As cheesy as it sounds, taking a couple of dance classes a week makes me feel like I am finally myself again.  I have missed this artistic side of my life so much, and I feel incredibly blessed to be able to jump back in!

I am 5 months away from the most important test I will ever take.
In mid-June, I will be taking Step 1 of the USMLE.  This is the first part of a board exam to become a doctor.  In May, I will have finished my two years of classes in medical school. I will have about a month of studying devoted solely to reviewing the material that has been covered over the past two years, and then, the test.  It is a day long exam, which I have grown accustomed to in med school at MUSC, but the outcome of this test could determine the course of the rest of my life.  No biggie.  Basically, you get one shot to take the test.  As long as you pass, you are stuck with whatever score you earn.  If you fail, you can retake it.  The score is the way that residency programs weed out people for the interview process.  Certain specialties and certain programs will only look at people with certain Step 1 board scores.  As I am hoping to enter into a surgical residency (at least that is the plan at this point), I need a moderately competitive score to get into a program.  At least I am not shooting for orthopedics, dermatology, or ENT! :) So fingers crossed...the studying has already begun!

In summary...
Life is insane right now...with changing jobs, tons of schoolwork, and a little extra time devoted to one of my greatest passions (besides medicine, of course!).  But it is also absolutely wonderful.  I cannot complain at all. Mikey and I are both working towards jobs we love and about which we are extremely passionate! We have two adorable dogs to love on as we are waiting for the right time to start expanding our family.  We have amazing families that support us (and feed us often! Thank you!) And we have wonderful friends who are patient with our hectic schedules and always there when we need them.

We are blessed and so thankful for all we've been given.