When I chose Laryngology as my 2 week surgical specialty elective, I did not know there would be so many secretions [of many types] and so much gagging. [The gagging really caught me off guard--mostly only during scoping without numbing FYI]
ENT was basically uncharted territory for me. The closest I had ever come to understanding anything about ENT was getting my tonsils out when I was 8. Other than that, it might as well have occurred on another planet, because I literally knew nothing about it.
I chose to immerse myself in this field because 1) I wanted to be in uncharted territory 2) I liked head and neck dissection in anatomy 3) I thought there would probably be nothing for me to do in the operations [shit, I was wrong.], so I wouldn't mess anything up.
Watching people regain their voice was phenomenal. The surgeon I was with, Dr. Ekbom, is the bomb. His empathy for his patients oozes from every piece of him and he is literally the kindest person I have ever met. He takes pleasure in his work because he is doing so much good for his patients. His patients love him because he is honest, he gives his all, and he has unending empathy.
Laryngology is not all about the voice and it's qualities. It is also about preserving, maintaining, and resurfacing the airway. When your vocal cords become paralyzed bilaterally, your ability to breathe through your upper trachea is almost always compromised. Not only can you lose your voice, you can lose the ability to breathe through your mouth and nose.
I have never had so much respect for the patient experience as these two weeks spent in ENT. The patients that undergo ENT surgeries are brave as hell. Letting someone up in your face and neck is SCARY. Think about it. Taking a tumor out of your airway or lasering your tracheal wall is like letting someone to put a plastic bag over your head while you're unconscious and trusting that they'll help you survive. But most of these patients unfortunately do not have good, long-lasting alternatives to surgery. Nonetheless, all the ENT surgeons I encountered at Mayo were experts and did phenomenal work on super complex patients.
My part in each surgery I participated in was substantial. The teams utilized me and dare I say, relied on me. Yeah, ok, I'm super replaceable, but who else could finagle their 5 foot 1.5 inch body into weird contortions to retract and suture the way I did? That's what I thought you'd say.
I think they enjoyed having another two hands in the OR because I could do little things that saved them time both during the operation and in the OR shuffle -- get IV fluids, plug in headlights, put on leg compressor stockings, move beds, put in IVs, plug in IVs, put on all the anesthesia garb, mask, ventilate, move expensive microscopes, answer pages, the list could really go on forever. Other times, I was just an extra person to take reliable and in-depth histories or someone who could read imaging and report it quickly to the team later. Sometimes I was the only one who had recently studied basic science and a broad range of medical diseases, providing the team with info about comorbidities that patients had or drugs they were taking.
The biggest thing I accomplished in these two weeks was continuing to develop how my voice can be utilized for others. In some situations on ENT, that was a literal voice. But in more abstract terms, I'm understanding the scope of patient care in all of these specialties throughout third year so that I can 1) hone/develop my medical knowledge, but ultimately figure out how I can be the biggest, best asset for my patients. Watching all sorts of medical specialties do this well or poorly continues to help me mold my own idea of what I want patient care to look like.
I think my biggest take aways from my two weeks were these:
●Pushing yourself into uncharted territory is the best way to grow.
things are not always the way they appear. You literally never know what you can learn in new situations and how you will be able to apply them to learning/living in the future.
● Empathy and kindness go a long way.
I don't have anything to add to the above statement other than being kind shouldn't be a choice for you. It should be your default. [remember that it takes a lot more energy to be mean.]
● Being a good doctor is easier than you think.
you may not know every answer. you may not understand every drug mechanism. but if you know how to use your resources, how to find out the answers you're lacking, how to think on the fly, and how to love on your patients you can provide some pretty damn good care.
●you may be the only advocate your patient has
this is your privilege as a trusted medical provider. you have an opportunity, really a GIFT, here. don't throw that away.
This week I was on anesthesia servive-- both adult and 2 days of pediatric.
Anesthesia has a steep learning curve. Though I know a lot of the drug basics and have the basic human body physiology mechanisms engrained in this giant brain, applying them within a moments notice is more challenging than you’d think! Though I’ll probably never be formally tested on the things I learned this week, they are super relevant to understanding basic physiology and were a great brain exercise.
Here are some things that helped me tremendously during my week on service:
Again, super helpful to know your patients ahead of time.
Know the ORs your provider will cover so you can record the following about the patients for your rooms:
Just a few tips and tricks! hope they are useful for you!
What do you want to read about next?
I started my surgery clerkship with the new year and it has been a whirlwind. My first week has been in ENT surgery, focusing mostly on the vocal cords. We did operations to fix vocal cord paralysis, subglottic stenosis, and I mixed in a day of thyroidectomies/tumor removals/trachea resections too. Scattered throughout the post, I have mixed in random surgical selfies from the past 8 years lol. You're welcome.
As a premise to this rotation, I hate the OR. I think surgery is fantastic and the ability medical professionals have in surgery is AMAZING. We [and I'm including myself minimally] resected a diseased piece of trachea and literally SEWED THE OTHER TWO PARTS BACK TOGETHER. Did you even know that was possible? It was pretty cool. I hate the OR mostly because I feel so uncomfortable when I'm scrubbed in. I have scrubbed in a lot during my medical school career in various specialties and no matter what, I always freak out and feel like I'm going to mess something up. A scrub tech told me--no that is actually a good attitude to have, because you are more cautious. OK--but it makes me feel TERRIBLE and anxious constantly.
So, here is my wisdom from my previous OR encounters and my recent time on ENT service. I think these are applicable during any time you are around the OR in medical school.
5. wear a white lab coat [from the surgical locker room] over your scrubs [take it off for the OR obvi] Essential things for the pockets:
6. Wear comfy shoes - i think this is obvious. I have asics that are like walking on clouds. Bonus points if you wear compression socks. They have fun medical ones on amazon for cheap, but really any will do. This will save your little legs when you are standing for 12+ hours. I wear cushy columbia socks over my compression socks bc it adds extra cushion to my feet. Yes, columbia ones are the cushiest. Believe me.
7. Don't wear jewelry, especially earrings. Other people do and whatever, that's their deal. But 1) you're the student and everyone is hyperfocused on what you will do wrong. 2) do you want your diamonds falling off into the patient? DIDN'T THINK SO. don't wear your wedding ring. lol.
8. If you wear glasses, wear glasses straps. If you do it wrong it will look nerdy. But I hide mine in my bun, and nobody ever knows. They're cheap, easy, invisible. But then you don't have to worry about pushing your glasses up, them falling off into the body cavity, etc. Just super handy to have one less thing to worry about.
9. women only-- ok maybe men too? Just wear a comfy sports bra. OMG you will thank me. Again, columbia has my vote.
10. Ok, I just had to throw this in -- know how to scrub and how to maintain the sterile field. I'm hoping if you're using the above steps you already know how to do this....
by Kaylee Houde
Something I continue to see as a Career Coach supporting students coming out of university is the tell-tale signs of sleep deprivation. The thing is, in this information overload and, "Fear of missing out" world, it is easy to make sleep your second, third or even fourth priority.
However, as I went through university I had just suffered a couple of pretty serious viruses and my doctor's orders were to keep sleep as my number one. That meant at least 7 hours of undisturbed sleep time, and I consistently aimed for 8 or 9.
I also found that when I compromised sleep I would struggle with focus, accuracy, and patience - making the whole school day more difficult anyway. Thus, this post is all about the importance of sleep (not only on your grades but your well-being as well), building habits, and how you can still be an all-star student while prioritizing shut-eye.
Why Sleep is So Critical
I find that a lot of people underestimate the importance of sleep with comments such as, "You can sleep when you're dead," or, "I can catch up this weekend." The scary part is, these statements completely disregard what we know about sleep as an academic species. Yet, they persist because, "Time is money."
The research is pretty clear, when you do not get enough sleep it can seriously impact your stress responses, and even your performance in your classes.
University blogger, The Cosmic Road, summarizes: "Sleep is deeply connected to our learning process. At night the brain takes information that we learn through the day and stores it in our minds. Without sleep, the brain can’t process what you have learnt and it is not efficiently stored in your long term memory."
In fact, maybe you already knew this about sleep but you do not go to bed on time or seem to have way too many other things to do, so you still fail to get enough sleep. Well, that boils down to the choices you make and the habits you build every single moment of every single day.
How to Prioritize Sleep & Still Get A's
So how do you prioritize sleep while still finishing every paper, literature review, case study, chapter reading, and still get decent grades? Study smarter, not harder.
(1) Create a Plan
Take a look at all your syllabi, and create a schedule of what is due every day of your semester. Then, for big ticket items, such as mid-terms, set a reminder to start studying for them 1-2 weeks in advance. Next, estimate how many hours it is going to take you to write each of your papers from start to finish. Maybe it is 8-10 hours for a ten-page paper. Lastly, add about 5 hours onto anything you estimate for papers and mid-terms, to create a buffer zone.
I used to do this on a word document and cross-items out as I went. You can also keep this on a calendar, in a planner, or whatever else works for you. However, the important thing is that you schedule reminders to check your outlook before the start of each week so that you can plan your time accordingly.
Your weekly outlook might look something like this when you check-in Sunday morning:
Turn this into a schedule if you can, blocking time in your calendar, or drawing it out in your favourite Moleskine [amanda's edit: OR A PLUMPAPER PLANNER FROM MY GIVEAWAY!!!! **see insta]. Do whatever works for you. The more you do this the better you get at estimating how long things take, as well. By my fourth year of my undergraduate degree I was so good at this that I could schedule a paper in for a Saturday and then have a whole Sunday off. Oh, and I usually got an A- because I knew exactly how much effort I needed to put in to get the grade I wanted as well.
(2) Stick to It
I get it, things come up. When something comes up and you cannot meet your commitments that means those hours either need to go somewhere else, or you need to eat into your free time. Otherwise, you need to take a lesser grade and/or take the risk of studying less hours for your midterm. It is all about trade offs. Knowing what those trade-offs are will help you prioritize. But, if you set your calendar up to meet all your deadlines, and you stick to it, you are building beautiful habits to reach your full potential!
For example, your day might look something like this:
(3) Reward Yourself
The other trick is to actually stay focused when you are in your "study mode" either by turning off your phone, or only checking it at certain times. Maybe you will say, after I read these 10 pages of my textbook, I will check my phone.
By setting little check-in points or rewards, you can get your studying done and feel productive in the process. I knew someone that used to leave a jelly bean trail on her textbook, so when she made it to the next page she would get her jelly bean at certain check-points.
Whatever works for you, that is what you need to employ. I would reward myself with Netflix and social activities (for example) for completing my papers a day early. It was like gamification for the university experience.
Study According To Your Energy Cycles
Michael Breus, author and sleep-specialist, backs up these tips and tricks with some actual research. His theory is all about planning your day around the kind of sleeper you are. Fast Company summarizes this in their article, "How To Design Your Ideal Workday Based On Your Sleep Habits."
That is right, this article says, "Workday," but if you treat school as your job you are not only preparing yourself better for the working world, but you prioritize things accordingly. Instead of sitting in the headspace of, "I am paying for my education so I can do whatever I want," I encourage you to take the stance of, "My education is preparing me for my career and thus I must treat it like part of that journey." Mindset is really everything when it comes to schooling. By taking this stance myself, I was able to clearly set aside each day my 8-10 hours. 2-4 hours of classes, 3 of studying, 2 for projects and papers, and another 3 for reading (or whatever mix you need based on your class syllabi).
It turns out that I am your typical bear as described in the article, which means that I, "...have normal sleep schedules, but may not get quite enough sleep.” When it comes to working we all have optimal times in the day. For me, I would easily stay up late in the evenings if I did not have a hard bedtime. Thus, because I had to have early morning classes (that was the only time they were offered) I literally had to turn everything off and make myself go to bed at a decent hour. I also struggled to eat breakfast, but knowing what I know about sleep and health, I would at least take a piece of fruit and a granola bar to eat on the bus. This made sure I had enough energy to participate in those early classes without passing out or having my body eat itself from the inside-out.
Also, by following my productivity cycles I knew when to set aside time for myself, or self-care time, or break time, or party time, or boyfriend time, or whatever else time you need to stay a happy and productive student. I would schedule my week so that, no matter what was due on Monday, by Friday afternoon I could give myself 3 or 4 hours of rest time. This might be to watch TV, hang out with some friends, go for dinner, or maybe catch a concert. This rest time is absolutely critical to combat student burn-out, and goes hand in hand with your sleep priorities.
Thus, next time you are tempted to binge watch Breaking Bad for the umpteenth time the same week you have a paper due, think about the habit you are creating. Rather than throwing your sleep-cycle out of whack and risking a D on your paper, how might you build in an episode or two in every day as a reward for completing your literature review, writing the first two pages of your ten page paper, or whatever other goals you want to set for yourself? Rewarding yourself like Pavlov's Dogs is actually the easiest and most effective way to train yourself into the effective habits needed to be your best self and also get enough sleep!
Kaylee Houde is a Career Coach, Blogger, and HR Professional. Working at some of the most world-renowned Oil & Gas companies, Kaylee has over three years’ experience in Change Management, Recruitment and Conflict Resolution. In 2017, Kaylee embarked on her journey to help others realize happiness in their careers as a Career Coach. She is specialized in supporting Millennials and those early in career who are in transition or looking for purpose in their work-life. Her mission is to help others reach their full potential through communication, collaboration and creativity.
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M3 at Mayo Clinic School of Medicine