To bagel or not to bagel, that is the question…

(This entry is a three-part series, detailing Jenny’s  tips on how to maintain a sound Body, Mind, and Spirit through clinical rotations)

As the alarm blares for my 4:35am wake-up, I think back to leisurely days of 9am lectures, wondering why I had been so excited to start clinical rotations. Sure, actually seeing patients, performing procedures, and discussing real cases was the reason I came to medical school, but life on the wards can be incredibly challenging, and not just due to the medical expertise required. Without much control over long, unpredictable days, even a health-conscious MS4 such as myself finds it difficult to stick with good habits previously cultivated, like 90-minute yoga classes, the occasional (antioxidant-filled!) glass of red wine, or a full 7 hours’ sleep. In addition, it sometimes feels superfluous to focus on myself amidst the demands of the wards, from writing admission notes to re-reading Surgical Recall. But throughout the past two years on the wards, I have realized that I am able to function as a more competent, caring clinician– and actually enjoy the experience– when I practice habits that keep me energized. Here’s what has worked for me during the last two years of med school:

Part I: THE BODY

  • Skip the bagels. I’m trying to stay away from obvious advice here, but I found this tip ridiculously hard to practice– just think about all those pastries set out for morning report, the pizza at noon conference, and the late night frosty runs! Well, YUM, but now I know those foods make me sluggish in the middle of a long day. Because it’s hard to avoid grabbing a pastry when you are starved, I always pack granola bars or mixed nuts in my white coat for emergencies. I also buy lunch when the free food is greasy Chinese… again. Not so healthy for the wallet, but you can’t put a price on feeling good.
  • A bagel is better than nothing. On the other hand… eat! Life on the wards can be feast or famine. I remember going straight from an eight-hour colectomy to seeing post-ops with a surgical intern without a bite in between.  At first I was embarrassed by my weak human need for food. Then I remembered how much more present I would be with something in my stomach, and unabashedly whipped out my granola bar for the walk to the floor. As long as you keep up and offer a bite no one will mind. And if there’s no granola bar with you, a bagel will just have to do!
  • The human body is 2/3 water, and it needs frequent replenishment to avoid that dull, headachy feeling. I therefore try to have a water bottle on me for case conferences and other seated activities, because you can’t drink on walk-rounds. I also learned very quickly not to over-hydrate, especially before scrubbing into long neurosurgery cases. Find the balance that works for you.
  • Empty your pockets. Living anatome has a great description of white-coat kyphosis, a common problem. My solution? To leave a bag in the team-room and empty my pockets. Nothing valuable in the bag – just the aforementioned water bottle, granola bar, and Surgical Recall, plus whatever scope and HPI forms I need for the day. Then I round with only a little notebook and thereby avoid shoulder and cervical nerve impingement.
  • Stand up straight. This is crucial, especially during surgical months. When retracting for hours, I make an effort to align my feet, legs, pelvis and trunk, bring my shoulder blades onto my back (for specifics see “Doin’ the Surgeon’s Shuffle” blog entry), and try to avoid unnecessary arm contortions (sometimes impossible). As an added benefit, good posture makes it easier to stay awake and makes you look more confident.
  • Breathe. Duh. But seriously, breathe. If you’ve taken even one yoga class, you’ve experienced a long, slow inhale and exhale. Do one of those after an attending asks you an unfair, ridiculously nit-picking question, and you’ll respond like the medical school superstar that you are.

 

Part 2: THE MIND

  • Don’t try anything new. I had a friend that tried to take up swimming and adopt a vegetarian diet during third year and guess what? She’s still an omnivore on the elliptical. Third year is not the year for ambitious new exercise plans; this is a year for making one small healthy choice after another. Yes, New Year’s resolutions are less exciting, but keep it realistic and actually succeed.
  • Lose the “all-or-nothing” attitude. When I haven’t slept in days or run in weeks and I just ate a donut for breakfast, it’s tempting to write the day off as a loss. But if you’re like me, those days happen A LOT. I realized I could still take a walk before hitting the library and have an apple with dinner to end the day feeling good. 20 minutes of Pilates? Better than none. You get the idea.
  • Do what makes you feel good. After 12+ hours on my feet doing what other people tell me to, no way can I force myself to pound out 5 miles on the dreadmill. Yoga has been my lifesaver for that reason – it always feels good and I look forward to doing it, so I always do it. Find an activity you like so that exercise isn’t another demand on your already-limited time, but something to replenish you and bring you joy.
  • Use your knowledge. One of my favorite moments of third year was counseling a patient to walk from the parking garage to her office to get more movement in her day. At first I hesitated – I couldn’t remember what I had learned about giving advice on physical activity and wondered if what I was saying was appropriate. But it was common sense, and I’ve been living this healthy-lifestyle thing long enough to know it was good advice! I saw a light-bulb go off for her and it reaffirmed that my commitment to my health can benefit my patients, too.

 

Part 3: THE SPIRIT

  • Health on the wards includes being emotionally well. I find staying grounded, enthusiastic and compassionate one of the biggest challenges. This is, again, where my yoga practice helps. Yoga teaches you to observe your thoughts instead of instantly agreeing with them. When I don’t know a lab value on rounds, I try not to berate myself but focus on accepting where I am – a student who makes mistakes that I can learn from.
  • I also frequently recall a yoga class where the teacher said, “Don’t make it a feat” as we attempted side crow pose. This wisdom helps me approach challenges like working up a possible bowel obstruction in the ED without getting overwhelmed – I just approach it with steadiness instead of making it a huge deal in my head.
  • My final and most important tip comes from yoga, too – be present. Life on the wards can be exhausting, exhilarating, overwhelming, painfully boring, and everything in between. I try to take it all in and focus on each moment instead of always worrying about what comes next, and I think this makes me a better student and happier person. It isn’t easy, but that’s why just like yoga, medicine is a practice.

 

About the author

Jennifer Gapinski is finishing her MS4 year at Columbia University’s College of Physicians & Surgeons; following her upcoming graduation, she will be starting her pediatric internship at the Mount Sinai Medical Center in NYC.

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