New Adventures

As I have not updated "Life in Libby" for a few months now, you have probably figured out that I'm no longer there. Here's a rundown of what I've been up to lately and what my plans are. I probably won't blog as frequently as I did from Libby, so don't hold your breath for the weekly postings, but I will try to keep it updated as I embark on new adventures.


First order of business: What does "E X P A N S I O N" mean?



Since starting medical school, I have always told my fellow meddies that I was planning on "expanding" my fourth year. Mostly, I wanted to impress them that I knew this was an option and talk about my cool friends who were upper classmen who had done it before me.

"Expansion" is the term UW uses to indicate that a student is taking the more than expected time to complete the four-year curriculum. Students expand for various reasons. Some choose to do research or embark on volunteer humanitarian pursuits, others have personal reasons for expanding such as starting a family or unexpected illnesses, etc. An unfortunate few are basically told that they have to expand because of failing grades, or being branded as "unprofessional" for one reason or another.

Then there are the few who aren't quite ready to make a career decision or say goodbye to their former lives: this is where I fit in. How do I convince the Deans that my time out of the wards will be worthwhile, you ask? How can they just let me go screw around for another year? Easy: I sell it. I tell them the main reason is that I want to pursue international medical rotations and experiences and that one year is just not enough time to accomplish my goals. This is not complete fiction: I do plan on going to Malawi (Africa) and South America during my expansion, but is this the main reason I chose to expand? No.

I only half believed that I would actually do it, thinking that there was no way I would go through with prolonging the misery of medical school. I guess I figured that the more I talked about it, the more likely I would be to follow through with it and would 't be able to back out because I didn't want to face all the questions like, "So, Emily, I thought you were planning on expanding; what happened to that?" and then having to save face and come up with some lame excuse why I decided to join the throngs of traditional uptight medical students whose main goal at this point in our education is to get into the best residency program. So, I kept talking about expanding for three years. The times I most knew I was going to expand: after beginning my third year last summer and February 19th, 2009.

Last summer was the first year since I was 13 (that's actually 14 consecutive years) that I did not spend on the rivers of Idaho. It was absolutely miserable. I think I went into a clinical depression for the first time in my life. No fresh mountain air, clear mountain streams, rush of whitewater lulling me to sleep. No hot sun on my shoulders, cooling off in snow melted creeks, warming up in hot springs. No campfires, high water stories, bullshitting on the sweep with the fellas drinking cheep beer and burnt cocktails. Mostly, though, I was apart from my home and away from my heart: the Middle Fork of the Salmon. I can honestly say that I am never home or content until I'm back on Mother Middle Fork. Some people float the Middle Fork and have a great time, but that is all it is for them: a vacation. Others truly "get it" (if you don't know what I mean by this, you don't "get it"); these are the folks I love sharing my home with and watching them come to understand the power and beauty of the place. Then there are those of us who the Middle Fork "gets into" us. It has gotten into me and since missing a season guiding last summer I've realized something about myself. I know that where ever medicine takes me, whatever career path I choose, I have to have rivers. I have to be at home and near my heart. If I forget that now, I may never get back to it or back to myself. So I'm buying time to figure out how to keep that part of me alive. I don't want to be a bitter, burnt out physician who got lost along the way and lives to work or works to live. That is not me.

So what happened on February 19th, 2009? I received an ecstatic voice mail late one evening in Libby after being on call and getting all my new COPDers "tucked in". Aaron's voice was frantic. The last time he'd left a voicemail with that inflection, he was telling me that Dad had a motorcycle accident, broke ribs, collapsed a lung, and was being life flighted to the hospital. Immediately, my thoughts went to a bad scenario: someone was hurt. I could barely tell what he was saying. He was talking frantically and out of breath. My mind was trying to slow his words down. Finally, I was able to interpret his last phrase of the message: "WE'RE GOING ON THE GRAND CANYON!!!! KATHERINE DREW A PERMIT. NEXT MARCH WE ARE DOING 21 DAYS ON THE GRAND, THIS IS SO FRICKIN' INCREDIBLE!! WE'RE GOING ON THE GRAND, WE'RE GOING ON THE GRAND, WE'RE GOING ON THE GRAND!!! WHOOOOO!!" The next morning I filed my paperwork to the Dean's office for my fourth year expansion.


Second order of business: What have I been up to?

The last three months have been a whirlwind. Since leaving Libby it seems as though life has been nonstop and this is the first weekend that I have had nothing to do (well, I do have things I could do, but I'd rather not, so I'm procrastinating them a bit longer). Here's a rundown:

• Leave Libby June 20th.
• Rig for MF trip June 21st.
• MF trip #1: June 22-27.
• Back to Boise to study for boards.
• Fly to Seattle for OSCE (a UW test on clinical skills, examination maneuvers, etc).
• Fly to LA for USMLE CS (board exam similar to UW's OSCE, but this is a national test all medical students are required to take in order to get the "MD")
• MF trip #2 and 3: July 17-22 and July 25-30.
• Back to Boise to study for more boards.
• August 10th: USMLE Step 2 CK: the "big" test of the year (and last standardized test of medical school)
• August 13-20: volunteer for First Descents, a camp that teaches young adult cancer survivors how to kayak.
• MF trip #4: August 26-30
• Back to Boise: throw a surprise birthday party for Aaron.
• Present: hanging out in Sun Valley at Tom Pomeroy's (a fantastic person and guest on the last Rocky trip) with Aaron and Annie hoping to catch a paragliding flight, but content to read, bike, hike, run, nap, and blog.
• Future: MF trip #5: Sept 10-13. Hells Canyon with M&D Sept 17-20. Back to Seattle for Autumn quarter.

Third order of business: So what am I really going to do with the rest of my life?

In short: I don't know for sure, but after a lot of reflection, mulling, and back and fourth indecision between Family Medicine, Surgery, and Internal Medicine, I can tell you that I'm 98% sure I'm going to pursue Internal Medicine. Why?

1. I like working through the puzzles the patients' present with (hence the mulling and reflection as mentioned above).
2. I like talking to people (they are asleep in surgery!). It is more fulfilling and gratifying to me to make a personal connection with someone and have them show you their gratitude and it is cutting them open, fixing them, and putting them together.
   
3. I'm not too psyched on kids (big surprise, right?) which is a big part of family medicine
   
4. I like keeping my options open a bit (there are lots of avenues I can take with Internal Medicine)...rural, urban, generalist, specialist, inpatient, outpatient
   
5. I LOVE old people! There's lots of them in IM.