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The emergency department doesn’t sleep, and quite frankly, my sleep schedule is consistent with the hours of my ED shifts. I work all of them. Day, evening, swing, unit clerk, tech, sitter, triage, 8s, 12s, 16s, and now, the occasional…night shift. And that’s the thing. I usually don’t work a stretch of nights. I’ve worked 1-2 in a row at most and transitioned back to normal, but not necessarily with ease!

In fact, I hadn’t pulled an all-nighter ONCE in my life until I worked my first night shift last summer… I was always the kid at sleepovers who wanted to go to bed before midnight. If I’m being honest, I dreaded this moment – the one where I had to work while the rest of the world sleeps. I didn’t want to mess with my sleep schedule, I didn’t know what to expect or how things are run, and I had a lot of anxiety about it.

But surprisingly enough, the girl who was dreading nights ended up enjoying night shift – would maybe go as far to say preferring it!! Much of my anxiety with these stemmed from not knowing what to expect. When will I take my break? How busy is it during the night? What if I get too tired to function? From someone who had no idea what they were doing, or what to expect, here’s how I can ease YOUR way into nights – all the things I wish I had been told.


BEFORE night shift:

  1. Shower & brush your teeth.

For no other reasons besides the fact that a shower wakes you up, makes you feel clean & refreshed, and smelling good throughout the rest of your shift. Before my first night shift, I forgot to brush my teeth that night. TMI…? yup. I wish someone had told me that it makes a huge difference. But that’s why I blog. 😉

2. Glasses > contacts.

If you wear glasses/contacts, take your contacts out and swap for your specs. Tired eyes are not fun, but they’re even worse when you have contacts in. Just do yourself a favor and wear your glasses!

3. Don’t bother wearing makeup.

Ladies, if you happen to meet your future spouse on night shift, I guarantee he/she will not care what you look like either. This gives your skin a chance to breathe. Even though you’re not “supposed to,” rubbing your eyes feels great, too. Just be comfortable and moisturize your face well. 😀


DURING night shift:

  1. There are less people around.

Guess what? At 3 am, there aren’t as many people roaming the hallways of the hospital. Most people in the world are sleeping. Now, no guarantees here, but this usually means you have less patients, too. You tend to be a little more “free.” For me, this means wearing a sweatshirt over my scrubs to stay warm and taking a 4 am coffee break.

2. Eat when you’re hungry.

Don’t eat because you feel you have to take a break at a certain time. I usually don’t bring a full “meal” with when I work nights. Instead, my go-tos are usually:

  • a banana
  • a protein bar
  • water/sparkling water
  • raw, chopped up veggies – like bell peppers!

In fact, I find myself feeling the need to eat, but when listening to my body, I’m not actually hungry. Eating small snacks throughout will make you less full overall and probably decrease your chance of feeling nauseous in the middle of the night, like we have all experienced. Oh, and drink lots of water to stay hydrated.

3. It’s a normal shift.

Sure, you’re working when the world sleeps, but (especially) if you’re in the emergency department too, it’s just like any other shift. I am assigned the same tasks as I’d carry out during a day shift. The ER is a well-oiled machine that functions 24/7. The only difference with night shift is that you’re working in the middle of the night. This is great to tell yourself if you’re any bit anxious about how the night will go.


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Stella was yawning too. Or maybe just that happy to see me when I got off work.

 

AFTER night shift:

1. Brush your teeth and shower.

Yup, you probably just did this before your shift. Get those hospital germs off before you sleep. Wash your face and hair, and brush your teeth. In other words, make sure you take care of yourself.

2.  Sleep for 4 hours.

Yes, 4 hours. Think of this like a nap. If you feel ok, get up and go do things. Make lunch, exercise, do what you have to do. If you’re too tired to function, sleep for a few more hours or watch an episode or two of The Office or Grey’s Anatomy until you can get up to “normal” human function. This is hard on your body – it doesn’t like to be awake throughout the night, after all! Be nice to yourself, too.

3. Melatonin. 

There it is. If I know I’m going to have trouble falling asleep, I will take 2.5-3 mg of melatonin anyway. But after a night shift or two, I take 5 mg (the max dosage recommended dose one should take is 6 mg) about 2 hours before I want to be sleeping. It knocks me out and keeps me asleep. I usually feel great when I wake up. Because your sleep schedule is all out of whack now, I take half that dosage of melatonin (2.5 mg) the following night. I’ve had no problems since. 🙂

What else?

  • The environment seems to be much more relaxed. My department turns the lights down in the nurses’ station, we wear jackets to stay warm, and
  • It’s a lot easier when you go into work if it’s bright out. My department doesn’t have windows, so if I go in when it’s bright outside, it never really “feels” like nighttime. That’s because of the melatonin production secreted by the pineal gland in our brains. Melatonin is released when the receptors in our eyes pick up light. Science is cool.

 

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It’s a tiny little structure!!!

 


And with that, I present to you, the night shift, as told by the non-night-shifter. Comments? Questions? Feedback? Shoot me a message!

All my love,

xx,

M

A morning with an on-call cardiologist can be as variable and exciting as the days the emergency department has graciously prepared me for. Here’s how I spent my morning:

I started the day chatting with Dr. G’s nurse about the schedule, procedures, and variability in patient cases in cardiology. After Dr. G, an interventional cardiologist, had finished rounding for the morning, I joined him to see his first and only clinic patient of the day. The individual had a new onset of shoulder pain when beginning a new exercise regimen, and after both a negative EKG and stress test, was cleared. Dr. G did an exceptional job of explaining everything to his patient, reaffirmed by the genuine “thank you” and kind words he received. This was an excellent reminder of the clinician I aspire to be.

After finishing up with the sole clinic patient of the day, Dr. G and I headed to the cardiac catheterization (cath) lab. Dr. G was on call, but simultaneously had two scheduled angiograms to rule out occlusions.

The first procedure, I observed from the station with the cath lab techs and nurses who explained the procedure to me. I quickly realized how brief the procedure was (only about 15 minutes start to finish), and then reviewed the pictures with Dr. G. It was negative, but very interesting to watch the contrast flowing through the coronary arteries!

The second procedure, another angiogram, Dr. G invited me in the cath lab. I donned surgical scrubs, gowned and gloved (and masked), and wore lead to prevent radiation exposure. This time, I was able to see Dr. G thread the radial artery and inject dye through and into the heart. Unlike the previous angiogram I saw, there was notable blockage and Dr. G concluded that the patient would need either triple or quadruple bypass surgery rather than cardiac stents.

The photo depicts an image similar to what I had seen on the left.

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coronary angiogram – A: before cardiac catheterization (notable blockage) B – after cardiac catheterization; occlusion notably improved **not my image** (see below for image credit)

After talking to Dr. G about conscious sedation, he explained that he uses Versed and fentanyl and only the smallest amounts to start, because it isn’t necessary to completely sedate the patients during the procedure. He explained that he can always increase the dosage if the patient is uncomfortable.

Lastly, Dr. G got a page from the internal medicine doctor for a patient on the floor. This too, presented a learning opportunity for me – I listened to abnormal breath sounds and heard a heart murmur for the first time.


A few things that drew me in:

  • the opportunity to educate patients about their health and how to make lifestyle changes.
  • the near-instantaneously relief that interventional cardiology provides in such a small, minimally invasive procedures.
  • the high-acuity and helping sick, sick individuals recover.

 


Three takeaways: 

  1. Interventional cardiology is more reactive rather than proactive.
  2. Educating the patient is probably the most effective way to not only achieve greater patient satisfaction, but will also increase the probability that the patient will be motivated to make changes. 
  3. The correlation between heart disease and diabetes is notably strong. 

Shadowing physicians and being in the hospital, especially at the beginning of a long semester reminds me why I still choose medicine every day. The opportunity to spend an entire day with the gift of having the ability to improve someone’s quality of life sounds like a career I still hope to have.

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I look like a surgeon.

For my guide to having a positive shadowing experience in the hospital yourself, click here!

Thanks for reading!

xx,

M

 

**Image credit: https://www.researchgate.net/figure/Coronary-angiogram-A-Total-occlusion-of-the-mid-RCA-and-70-narrowing-of-proximal-RCA_6875106_fig2

My friend over at @heardtohealed on Instagram, Stephen Groner, has combined his experiences of being an ENT patient, and having a career in speech-language pathology and wrote a book full of simple ways for you and I to improve our interactions with patients – making our jobs more enjoyable, and our patients’ satisfaction greater!


Stephen breaks down bedside manner into three chapters:

  1. Starting: Impressive First Impressions
  2. Listening: Giving Them the Mic
  3. Talking: What to Say and How to Say It

In my clinical experience so far, I have found that it can be challenging to relate to patients, relay information, and rationalize a scenario with a patient or their family when they are angry, frustrated, or feeling other hard-to-cope-with emotions. Though these situations tend to get easier the more one experiences them, it remains difficult to know if you are doing or saying the “right thing.” According to Stephen, you’ll learn that sometimes silence is better, and a gesture means more than finding the right thing to say.

Read this book, a quick read (under 70 pages), and reference it when you want to refresh your approachability and success with your patients and your interactions with them. Find it in ebook form here for only $7! I am so glad I read this book, not only for how I can work on the dynamic I have with my current emergency department patients, but also with skills I hope to integrate in my future practice as a physician!

Happy reading! And while you’re at it, go check out Stephen’s page for inspiration and humility!

xx,

M

 

I spent this weekend at a small lake in the woods in Minnesota before the craziness of the school year begins. Without even saying it, I’m sure you could guess that I finished most of yet another book! This was such a perfect way to close out the summer.

In this memoir, Dr. Kathy Magliato writes about her path and current life as a cardiothoracic surgeon (one of the few women in the field) as well as a heart transplant surgeon. Her story consists of multiple stories that get her to where she’s at today including having children despite the busy lifestyle her career gives, being married to a liver transplant surgeon, and how her training made her an ever stronger person.

Dr. Magliato is hard on the outside, strong-willed and does not give up, but she also describes the kind of physician she is in that she sits down with her patients, prays with them, and offers them her “free” time and her full attention.

Her stories are both motivating and inspiring to me and Dr. Magliato’s work and philosophy of putting her patients first is exactly the kind of physician I aspire to be.

Read if you are interested in the life of the operating room, the rigorous training of becoming a specialized surgeon, and what it’s like to be a minority in the field of medicine – and prevail.

Do yourself a favor. Read this one. 😀

Find it for about $12 on Amazon and to read more about Dr. Magliato, check out her website!

Happy reading, friends!

xx,

M

 

 

It has taken me a long time to figure out what really works for me in terms of learning. I wish I had the ability to read something once and fully understand it, but I am no Lexie Grey. If you feel you have the same terms of memory capacity as the fictional doctor, consider yourself lucky.

If you are like me, and NOT like Dr. Grey, keep reading and I’ll tell you how I study efficiently. 😀

I’ve found my brain likes to write and I best understand a concept by doing. I’ve found that hands-on courses like labs and simulation activities are the types of of courses I excel in. Learning this about myself has taught me to adapt my studying by how I personally learn best.

If you find yourself a visual/hands-on learner, keep reading. Here’s how I study!

Before class:

  • I download the notes the professor has online before class. I will either download them to my computer or iPad, or print them out.
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I use my iPad every single day. 

 

  • I check the syllabus to see what will be covered in class that day and skim through the textbook if I have the chance to do so. This helps simply to be aware of what will be covered in class that day.

 

During class:

  • I listen to the professor’s lectures and write down important concepts. This is done by circling, bolding, highlighting, or sometimes when a professor says: *THIS IS ON THE TEST!* you bet I’m going to write that in bold, or brightly colored ink. Every student’s favorite words.
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I use the program NOTABILITY on my iPad with my Apple pencil. save the trees! 😀

 

  • I draw arrows and bullet points to their notes to help keep everything in the same category for my later reference and know exactly what is important when I’m copying down the notes

 

After class:

  • If and when I have a break after class, I will begin copying down ALL of the notes fro the professor’s including the material I have added myself – yes, that is right. I wish this wasn’t my brain’s best method because it is very time consuming but I have learned the hard way that this is what works for me. Ok, I shouldn’t say all of their notes, this includes paraphrasing, but you get it. The jist of the information professors convey is copied down into my notebook.
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Black pen, highlighter, and blue pen to copy my notes. Most of the pens are hopsital-acquired. From taking them home in scrub pockets. Relatable? 😀
  • I write the bullet points in black ink and write in answers to practice problems and/or extra information in blue ink. I draw pictures in various colored ink, and I highlight and bold important concepts. This way, when I’m reviewing for an exam, I can skim through and the bold and highlight will catch my eye.
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sketches, drawings, black ink, highlighter. histology! 

 

  • If a concept wasn’t clear through the professor’s notes, I will refer to the textbook and/or YouTube, specifically Khan Academy to clarify a topic or subject. I will add – in my own terms – the difficult topic to my copied notes from class. Acronyms/mnemonics are written in blue ink alongside my skeleton of black notes.
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red & blue ink for the cardiovascular system! anatomy

Before an exam:

  • Flashcards and note review – I write out difficult concepts or terms on flashcards and quiz myself. My notes are highlighted and bolded for reference that my future self always thanks my past self for 😀

 

  • Talking though a concept repetitively. This works really well with going through the flow of blood through the heart, or the metabolic pathway a certain protein channel. I have a friend take my notes and I recite the information back to them. If I don’t know something, I think of something that will remind me of it. I’m going to do an entire post on acronyms, ok? It is also beneficial to talk through and draw a process with a friend/study partner.
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whiteboards and concept mapping is VERY HELPFUL! 

 

  • I DO NOT STUDY THE NIGHT OR ESPECIALLY THE MORNING OF A TEST. My brain hates this. I control any test anxiety by stating I will only know what I know 24 hours before an exam and that I won’t learn or retain anything new past that point. Cramming makes me crazy. Instead of doing so, I will REVIEW material such as skimming over notes and reading the highlighted material. Sometimes reading them out loud helps me.

 

  • Trusting in my preparation – this is KEY. My philosophy on exams is either you know the material, or  you don’t. Attempting to study and learn new material the day before an exam, the night before exam, or the MORNING of an exam trigger serious test anxiety for me. This is why I DON’T STUDY THE DAY BEFORE AN EXAM. Reviewing is different that studying. Reviewing is looking over a concept, refreshing your memory, or looking something up briefly. Studying is attempting to learn and integrate new information. While this may not work for me, it might for you – that’s ok. All I’m saying is I have learned to trust in my preparation and that alone puts me at ease & gives me confidence when going into an exam.

 

*What works for me might also work very well for you (that’s the intention), but because everyone is unique, my methods might not work for you. Just remember that. 🙂

How do you study? What works best for you? I’d love to hear your thoughts and feedback!

I wish you all the best semester and I hope you celebrate the little things throughout it! Happy studying!

xx,

M

The emergency room will always have a special place in my heart.

Regardless of anything I have personally experienced, it is well know that the ED is its own entity; its own unique branch of medicine that is nothing like the other areas of the hospital.

We see people at their very worse, sometimes grasping by straws for a chance at survival, and others, aren’t as patient with the wait time. There are sprains, strains, fractures, and lacerations all day, critically ill stroke codes, STEMIs, and traumas all night – well, not necessarily in that order. The department doesn’t sleep and any emergency personnel can tell you a plethora of stories that you might think are too bizarre to be true, but trust us, they are not!

This is best illustrated in the story by Dr. Paul Austin in Something For the Pain: Compassion & Burnout in the ER.

With my continuing experience in the emergency department, I enjoyed reading the struggles and triumphs Dr. Austin faces as an attending emergency medicine physician.

Dr. Austin discusses specific cases he has faced throughout his career and training, but not only that, he talks about how these patients and their stories affect him as a person and his family overall.

Having a career in emergency medicine is a high-stress at high stakes career. Dr. Austin describes how this career nearly ruined his family. It is a reminder that medicine is a rewarding, yet demanding career that proves that if you do not feel that you are taking care of yourself, you will not be best-fit to take care of others in what may be their most desperate times of need.

Read this one to gain insight into life from the trauma bay, the stories on night shift, the forbidden “S” and “Q” words in the emergency department, and the selfless side of medicine that the doctor taking care of you faces each night they try and sleep.

Dr. Austin’s website describes his book more and will give you a preview of his second book.

Find it on Amazon for about $10.

Happy reading, as always!

xx,

M

I was asked to write on the topic of being a pre-medical student and being discouraged throughout one’s time as an undergraduate student. I was asked how I remain motivated and keep my mind in the game despite trials associated with being a student in a intense program of study – that won’t be getting any easier throughout this journey. 😀

That’s just it.

Every career path experiences trials throughout, but what is the difference between the people that succeed and those that feel defeated?

The secret is that there isn’t one. I personally am not consistently ready to conquer the world; it’s not humanly possible. There are days where I want to take week off from school and “catch up” on sleep. There are times where I wish I was out with my friends instead of studying, and even days where I wonder how people can spend their entire summer days in a hospital from sun up to sun down. But why do I keep going? Why do WE keep going? Ask yourselves that!

I believe it is NORMAL to feel this way. My experience being a student is that overall, I am always motivated, but I take each day at a time regardless of how I feel.  My end goal is in sight.

Here are a few things I do that keep my head in the game.

Working in the hospital.

I will dedicate an entire post on how the emergency department as affected me as a person overall (for the better), but working in the hospital, let alone, an acute care setting, has given me a drive to push through whatever I am doing.

I have worked a while in the ED, and because of the experience I have already gained, I’ve questioned working in a different, non-health-related setting as an undergrad. Why continue working in healthcare if that’s what we’re going to do our entire lives? I have friends work in settings such as barista-ing, nannying, and other related positions which has worked out nicely for them. These experiences have given them the opportunity to work in a different setting, something they may not have as they are developing their professional careers. But for me, I thoroughly enjoy working in the hospital as an undergrad.

Each shift I work, I find myself learning new diseases, treatments, care processes, and I am surrounded by a network of physicians, nurses (bless nurses, seriously), and other trained healthcare professionals. Learning new things about healthcare and treatment catches me thinking and learning every time, regardless of how demanding that shift was.

Not only does the science behind medicine motivate me, but the patients do just as equally. As a tech, I am able to do things throughout my shift that can make time spent in the emergency department even a little better. As many patients have negative experiences with the emergency room, I feel grateful to be able to enhance someone’s life with even the simplest of gestures while they are in our department. I am able to hear stories from all different walks of life as well as have the privilege of getting to know these people on what may be some of the most unfortunate days of their lives. I am reminded that it is a privilege to work with human life each time I work.

Getting the most out of courses.

I have shadowed plenty, and almost every physician I have gotten to know have informed me they don’t use an ounce of organic chemistry or physics in their every day practices. This doesn’t sound motivating, does it? “Get through it, pass, learn it for the MCAT, and you’ll never use it again.” OK! What about courses like histology, cell biology, anatomy, and physiology?

The courses I just mentioned have been my favorite courses in undergrad thus-far, and it’s because they are directly related to medical school coursework. These courses are challenging, but there is nothing better than understanding a concept. What I have learned has provoked my interest and studying for those courses motivates me to succeed, learn more about medicine, and prepare myself better to becoming a physician. There is a reason why these courses are recommended prior to going to medical school. AND, you’re paying for your education, so you might as well get the most out of it and take electives you enjoy!

Read books & watch shows!

I wrote a post on my favorite medical shows and I also have a tab on my blog that reviews books I’ve read that are worth your time. Doing these types of things *that will simultaneously benefit you* in your free time will help remind you of why you are sticking with those long nights and early mornings. Not only that, but these providers will help you learn what kind of a provider you want to become.

Reminding yourself why.

If I find myself discouraged by a poor test score, stressed out by too many things to do, or feel so tired I don’t feel like I cannot function, I remind myself: “YOU ARE DOING THIS TO YOURSELF. You want to become a doctor. You want to enhance your patients’ lives. You want to pursue science, despite it being extremely challenging. You cannot feel bad for yourself.”We are privileged with the ability to study what we wish to study – remember that!

Here are some small things that may help you keep your head in the game as well!

  • take a step back. why are you doing what you’re doing? why is this your goal?
  • “if not you, who is going to do it?”
  • write down your goals so you can see them. keep a tangible object around you that will remind you of your end goals. *I keep my recycled Littmann & and ob/gyn pocket book in my bedroom right where I can see them. It’s amazing what a visual does 😀
  • do one thing each day that will motivate yourself. read medical literature. do something fun once a day. dress for the part you want. practice the “power pose,” remind yourself how awesome & capable you are.
  • reduce your stress – stay active! go for a walk if you get stuck on a problem. coming back to that problem might come right to you after you clear your head.
  • celebrate mini-milestones. you studied your butt off and killed that exam? you finished another semester strong? you got the internship you’ve been wanting since you were a freshman? go get a drink with your friends or reward yourself with a new pair of shoes!
  • shadow the career you are pursuing. Seeing what your future line of work looks like may bring you back to your goals.
  • make a list of your goals and how you are going to accomplish them. you could do this every day, one a week, once a month, once a semester, once a year, etc.

Keep each other motivated. Tell you friends how awesome they are. Enjoy the small things along the way. Keep reassuring yourself!

Thanks for reading! Always remember your goals!

xx,

M