The Best Workout You Never Knew Existed…

I didn’t either…until I became an OB/GYN intern and did my GYN Onc rotation.

What is this secret work out and are sign ups more competitive than Soulcycle?

NO!

Unfortunately, there is no fancy name for this workout: Uterine Manipulation During Robotic Surgery.

What is uterine manipulation during robotic surgery?

I’m so glad you asked!

Basically, robotic surgery is a fancy form of laparoscopic (“minimally invasive”) surgery that uses 5 ports (more than the usual 3 ports in “straight stick” laparoscopy) to operate. One main advantage of the robot is that you get “360 degrees of freedom,” meaning that the arms of the robot have a wrist, which conventional laparoscopy does not. However, after doing some of the robotic training modules and feel like my wrist could no move as I wanted it to, I beg to differ with the da Vinci robot company.

I like to call this instrument

I like to call this instrument “The Swan,” because that’s exactly what it looks like when the use it to push down the bladder in a hysterectomy. It looks like a swan stroking its feathers. I want them to rename that step “The Swan Move.”

Left: Console Where You Sit To Control the Robot  Middle: The Robot Right: Screen To Watch Everything On

Left: Console Where You Sit To Control the Robot
Middle: The Robot
Right: Screen To Watch Everything On

The other fantastic thing about the robot is the “undraping.” To maintain sterility, the robot is draped with a gown before you dock it at the patient. Every time, I’m like “here’s the Wizard of Oz moment! Let’s meet that wizard!”

You get where I'm coming from, right?

You get where I’m coming from, right?

Fortunately, I have never said any of these things out loud in the OR.

Anyways, back to manipulating.

In GYN surgery, you have to put a device into the uterus to help move it around during surgery so the surgeons can see what they need to see. If you’re curious, my favorite manipulator is the V-care. I have no idea why they named it that either (joking).

Usually, manipulating is the interns job or some lucky person who hopefully ate his or her Wheaties. They always tell you that “you just don’t know – the uterine manipulator is the most important person in the surgery!” We know this is like telling us “there are no small parts” when you get the token Angel in the Christmas pageant and not Mary of the Angel of the Lord.

The reason this is such a fantastic work out is two fold.

First, the primary job on the uterine manipulator is to, at all times, be “pushing in as hard as you can!” This then becomes the world’s longest and most intense isometric exercise. These surgeries can go on for hours. You think pulsing for that last 10 counts is hard? Try three hours. And, just when you sort of stare off into space and realize that you arm may be sort of numb, the surgeon asks you “you’re pushing in as hard as you can, right?! Can you push in any harder?”

Second, to both manipulate and maintain surgical sterility around the robot, you have to also have a Cirque du Soleil-eqsue like contortionist ability. Don’t touch anything, keep you arm up and over one of the robot arms, and push in as hard as your can. Or else.

Apparently, people aren’t as attracted to OB/GYN as other fields with better lifestyles. So, I have an idea.

At the beginning of the year, I’m going to instagram all of the interns dominant arms. At the end of his or her (usually her — this is OB/GYN) gyn onc rotation, I will take an “after” instagram showing the fruits of their uterine manipulating efforts.

And, if they fail, I will go all Tony Perkis in Heavyweights on them.

That’s the real reason I do all of these work out classes. To keep up in the OR.

Actually, no, the reason I really do them is to carry more seltzer home from the grocery store. Every time I leave Fairway or Whole Foods and don’t feel completely weighed down by seltzer, I think “one more 12 pack — you could’ve had that.”

Speaking of the grocery store, I have a confession to make.

I bought non-organic apples. They just looked better.

When I die of someone weird progressive neurological disease, remind me of this choice since every time you read “what foods to buy organic,” apples are at the top.

Ok, I’m bored of this post. You probably are, too.

One final thought: Pregnancy isn’t fair. People who are dying to be pregnant can’t. Those who don’t want to be are. Those people who are really sick with horrible medical problems can sometimes get pregnant but then it makes the disease worse (well, depending on what it is).  And then you have the partnerless who, in the age of assisted reproductive technologies, have a whole new paradigm of parenthood to consider – donor egg/donor sperm/single parenthood. And, then you also can’t eat unpasteurized cheese or sushi for 40+ weeks.

So, yeah, hats off to pregnant women.

It is far past my bedtime.

Night night.

Until next time.

Daily Coffee Tally: 1.5 (WHO AM I?!)

Sleep, Self Tanner, and the Sweat Life I Lead

Are you looking for the keys to happiness?

I have found them.

They are sleep and self tanner. Both make you instantly look and feel better.

I highly suggest trying this.

Sunday: The Day of Rest.

Since becoming a resident, I have become worse at resting. This is paradoxical and counter intuitive since my work is exhausting. If I were to be my own psychologist, I would suggest that the reason I do this is two-fold. First, I know my time off is slim to none so when I do have some spare hours I try to squeeze in every.last.thing. Spin! Go to the park! Spend like 2 hours in CVS looking at things I don’t need! Nails! Spending more money I don’t have! Write this blog that likely only a few people read!

Second, I have a life-long habit of not sitting still. This started when I was two and asked to do gymnastics. It continued when I was six and was in probably six different after school activities (thanks, Mom and Dad!), which I thought was the best life a six year old could lead (dance, gymnastics, soccer, tennis, piano — scratch that, I hated the last one). Being a life long athlete, I had a ample opportunity to not sit still. And, now, I run around at work, run around after work, and then crash into bed. Overall, I think this is my coping mechanisms for life’s anxieties, of which I have many, chief among them “matching into fellowship.” Writing those words makes me feel ill and start to sweat. So, yes, I likely seek the sweat life in order to not feel any other feelings other than endorphin fueled happiness.

See, who needs a therapist when you have writing and the internet?!

Sunday is also the day of the ritual I started in residency: the pre-work week pep talk.

Although I’m terrible at resting, my time after 5 pm on a Sunday is fairly relaxed, usually, unless I’m at work. This is because about now is when the “omg, can I make it through another week” starts to kick in.

Residency, like any job, is taxing. It takes a lot out of you – emotionally, physically, mentally. You have to give 100% of yourself all the time – both to learning new information, in taking care of patients, in teach the juniors, in being super detail oriented and conscientious, in trying to impress your attendings, and, overall, just trying to do a damn good job. But, being exhausted sometimes means you just can’t bring 100% to something. As type A as most doctors are, this is frustrating and then, I think, we spend extra emotional energy beating ourselves up over not being 100% perfect all the time. It’s this self induced torture that many of us put ourselves through.

Or maybe that’s just me.

Lack of sleep has made me slightly more relaxed though. I mean, sometimes I only use a one color pen instead of a four color pen.

Jokes aside, the Sunday night pre-work week pep talk is crucial. So, is the walk to work music.

Currently, Lupe Fiasco “The Show Goes On” or “Battle Scars” really hits home. I’m sure you didn’t expect this of me.

Final thoughts: Amongst the overabundance of specialty stores in Manhattan, there has yet to be a specialized seltzer store. This is, truly, a shame and, I believe, a missing hole in the landscape of niche food boutiques.

All I wanted today after I left Jess’ killer TRX/Pilates class was a seltzer over crushed hospital ice.

There’ s a specialty seltzer store drought in Manhattan. And, if this medicine thing doesn’t work out, I’m going to fill it.

Smith’s Seltzers. It has a nice ring to it ,right?

Until next time…

Daily coffee tally: 2.5

Little Luxuries

Saturday night…people are probably doing more interesting things than reading this blog.

But, regardless, I just woke up from a 2 hour nap so hard that I have creases on my face. When I looked in the mirror, I first thought “I look like Scar Face.” And, then I remembered I have no idea who Scar Face actually is — a criminal or a movie? But, let’s be honest, the ultimate scar face is none other than Harry Potter.

Days off are these precious gems that residents, like the rest of the working world, live for.

I started doing this “on days off I’m going to exercise as much as possible” habit as an intern and continued to do so despite extreme fatigue and thoughts of doing something more relaxing. [Jaws, you kicked me ass so hard today. Thank you.] As a resident, you get so used to pushing through fatigue that doing it one more day just seems normal. [Plus, I love exercising and all the classes that I do that I have a hard time saying no to something!] Can’t stop, won’t stop. This is not healthy, I’m sure, and it has been suggested to me that this is a coping mechanism for dealing with anxiety and other worries.

It likely is. But, better exercise than drugs or alcohol, right?

The nap had me thinking about little luxuries. Here’s a list:

1) Naps

[I feel like sleep is a figment of the New Yorker’s imagination.]

2) Long Showers.

[I even exfoliated and used self tanner today. It was what my friend Erika calls a “big dog shower.” Gotta look great under those scrubs, you know?]

3) Fancy Coffee

[They finally opened a Birch Coffee two blocks from me. I am thrilled as the fancy coffee options in this area left much to be desired. More on fancy coffee at a later date.]

4) Fancy Candles

[I bought a geranium mint LAFCO candle today in a big moment of weakness. However, I haven’t regretted it, yet.]

5) Boutique Exercise Classes

[This is my real weakness.]

6) Ordering on Seamless

[This is more of a necessity than a luxury for those of us not culinarily inclined.]

7) Mani-Pedis

[Although the NY Times article this year made me think twice….]

8) A Cleaning Lady

[This has changed my life. It has freed up about 3-4 hours out of my week.]

9) Being Showered and In Bed With Clean Sheets.

[If cleanliness is next to Godliness then this is like sitting on the God’s hand opposite of Jesus.]

Speaking of cleaning and laundry, a lot of my patients in the clinic at Bellevue have the BEST smelling clothes. Most of them are Hispanic. I have been dying to ask one of them what detergent they use. I have yet to do so for fear they will be like “My doctor did my pap smear…and then she asked me for my detergent?” I mean, it smells so good I want them to write it down for me.

If you’re wondering, I use Tide with Febreze, currently. It, too, smells nice. I think clean clothes do, in general.

Night Night.

Until Next time.

Daily Coffee Tally: 3 (two americanos and one small iced)

Obstetrical Spanglish, Birth Plans, and Salad Bars

No One Is Going To Read This On A Friday Night…but these little posts each night are becoming sort of a habit. So, I’ll write it anyways.

Today, I reached what might have been the pinnacle of my obstetrical Spanglish.

I was trying to explain to the patient that she needed to push very hard because the baby’s heart rate was dropping after each contraction (recurrent late decelerations, if you want to know the specific term) and that baby would not tolerate labor much longer (and, hence, the C-section she had shortly thereafter).

I think I said something along the lines of “Señora! Es muy importante to empuha with todo su fuerza! Todo su fuerza!”

(Translation: Señora! It is very important to push with all of your force! All of your force!)

I mean, I think that’s what I said.

It was super elegant and rolled off the tongue very nicely.

Along the lines of birth plans, let me say this: there is no crystal ball in obstetrics. As part of the “induction of labor” bedside chat I had many, many times when I did L&D nights as a second year, I emphasized this fact. There is no way to predict exactly what will happen between the onset of your labor (natural or medicinal) and the exit of the fetus from your corpus (either vaginal or abdominal).  You can have a terrible tracing. You can get chorio. Or maybe you’ll get lucky and the baby will fly out (usually with the 2nd or 3rd kid unless you’re really lucky like my former co-resident who thought she was 2 cm with her first baby and was actually 10 cm).

Then again, going against what I said, I do have a very specific birth plan for when I am pregnant. Epidural on arrival. AROM. Pitocin. Delivery of baby over an intact perineum OR ELSE. I also want to go into labor at, let’s just say, 38 0/7. I hope my fetus gets the memo. I would also like it to be approximately 6# 10 oz and in direct OA position (I’ll take LOA or ROA….fine) or else it cannot have Pirate’s Booty until the age of 5. DO YOU UNDERSTAND FUTURE FETUS?!

I’m not asking for too much right?

On a separate note, I had a super exciting Friday night. I went nuts at the Whole Food ssalad bar and bought full fat Greek yogurt (variety in fat percentages in your yogurt really is the spice of life, no?). I have no idea why I am not married.

I also bought a new flavor of La Croix seltzer. For my 30th birthday, I would really like a mini-fridge full of La Croix seltzer that I can solely dedicate for this purpose. I just need to find space in my 425 sq foot apartment for it.

Again, no idea why I’m not married.

Final thoughts: how can a person (such as myself) like olive oil but not olives?

Is this a mystery to anyone else?

Night Night

Until next time…

Until next time…

Senior Resident

I just prepared a presentation for tomorrow. The concept in the article (cerebroplacental ration predicting adverse perinatal outcomes) at first involved some diagrams to understand the metric (see yesterday’s post), but once I understood what CPR meant it was actually a good article to read. More words than numbers. And nice tables.

I remember when I was an intern and I listened to the third years (my current year) give their article presentations, I thought they knew so. much. I couldn’t fathom how I could ever know as much as they did because I was still trying to get a cervical exam right (i.e. that thing people measure with their hands in labor to tell you when its time to have the baby or not have the baby).

I’m still sort of grasping this whole “I’m a senior resident” thing. I still feel like I was an intern yesterday and realized I have learned a lot, but that there is still so much more to know. You can quote me on that. Stitch it on a sampler. Realizing you don’t know everything? Deep thoughts, I know.

Speaking of deep thoughts, today was National Hot Dog Day. I did not partake. Again, the timing and spacing of these food holiday celebrations needs to be addressed. Who do I take this up with? Obama?

I found out that Donald Trump is doing some really ridiculous things – like giving cell phone numbers out on national television. Jon Stewart is really retiring at the wrong time.

Daily Thought: Don’t underestimate the comfort of a workout onesie.

Night Night

Until next time…

Daily Coffee Tally: 2

Animals

7/22/15:

Do all working people feel like caged animals sometimes?

Today, when my co-resident pressed herself against the window and we all longed to go outside for 2 min (mostly do defrost since Bellevue’s AC is blasting in clinic), I thought to myself “we really are like caged animals.” Tied down by pagers and a strong urgency to get. things. done. Preferably, 5 minutes ago .

The benefit of this is not knowing anything that is going on in the world. If we get blown up by Iran, then it will be a surprise to me. And, apparently, Donald Trump said something derogatory (again) about something (are we surprised?). I’m fine not knowing.

What I do know is that math is confusing. And math is everywhere.

I was reading a paper today (two, actually, as I have to prep two articles to present this week). You know what will make you head spin really fast? Reading the statistics in a paper.

For example:  

“In the intention-to-treat group, vaccination also statistically significantly reduced the risk of any high-grade cervical lesions (19.0% reduction; rate vaccine = 1.43, rate placebo = 1.76, difference = 0.33, 95% confidence interval [CI] = 0.13 to 0.54), vulvar and vaginal lesions (50.7% reduction; rate vaccine = 0.10, rate placebo = 0.20, difference = 0.10, 95% CI = 0.04 to 0.16), genital warts (62.0% reduction; rate vaccine = 0.44, rate placebo = 1.17, difference = 0.72, 95% CI = 0.58 to 0.87), Pap abnormalities (11.3% reduction; rate vaccine = 10.36, rate placebo = 11.68, difference = 1.32, 95% CI = 0.74 to 1.90), and cervical definitive therapy (23.0% reduction; rate vaccine = 1.97, rate placebo = 2.56, difference = 0.59, 95% CI = 0.35 to 0.83), irrespective of causal HPV type.

Really cool information but my eyes are very overwhelmed!

Reading papers also makes me still realize that I can’t grasp some concepts without writing them down. Paper to pen is powerful, guys. side note: I still want to buy this weekly schedule notepad. Its graph paper!

Currently..

IMG_6475

Question of the day: How many salted cashews a day is one too many?

Gave up dessert. Replaced that vice with almonds, pistachios, and cashews.

Night night.

Until next time…

Daily coffee tally: 2 (one was even “high elevation grown coffee” which is apparently a fancy coffee thing now)

16 Patients

7/21/15:

Booking clinic was not as bad as expected. I think we saw 8-10 patients (me and my chief resident). We were able to finish by 1 pm, which was good (since the next clinic panels start at 1. I hope my preparation helped. Next week, there are 16 patients scheduled for booking. That seems absurd.

For those not in medicine, booking a patient for surgery can be a long visit. You have to make sure the patient is worked up properly, talk with and examine the patient, determine the surgery they are to have and the mode of such (i.e. minimally invasive, open, etc etc) and then discuss all the risks/benefits/alternatives of that surgery. Then, you have to find a date for them and make sure they get the appropriate pre-op appointments, labs, etc.

It is a lot of check boxes. It is simultaneously type A’s dream and nightmare.

So, 16 patients next week in 3 hours seems like a really…overwhelming and slightly impossible task for one booking panel. My shoulders are creeping up to me ears with tension just as I think about it.

An interesting post about waiting for the doctor: http://raphafamilywellness.com/blog/2013/9/18/why-in-thedoes-a-doctor-schedule-an-appointment-for-240-and-keep-my-ass-in-the-waiting-room-for-at-least-30-minutes

Your thoughts?

Apparently, today was National Junk Food Day. A few days ago it was National Ice Cream. I think we should really space out the scheduling of these “holidays.”

In fact, with the state of obesity in the nation, we probably shouldn’t encourage celebration of sugar.

Speaking of sugar, watch Katie Couric’s documentary, “Fed Up.”

Finally, in my quest for the perfect notebook, I found this cool furniture site: School House Electric and Supply company. I love the industrial desk. And, you know, iPhones are cool and all, but I’m still into pen and paper. If you want to buy my love, you can buy me this weekly schedule notepad.

I’m going to go read about HPV now.

Night night.

Coffee tally for the day: 1.5 (WHO AM I ?)