It's over! Let it begin!

I've been studying 12h a day for three months. No listening to music in the car, only audio reviews. There are post-its all over my apartment: the brachial plexus on the bathroom mirror, the Circle of Willis above the toilet paper, and the basal ganglia next to the coffee maker. I have a whiteboard covered with ridiculous mnemonics for memorizing inane but testable details. I ended up making 6800 virtual flashcards at last count - far too many to use for their ostensible purpose, of course, but the act of making them was valuable in and of itself. I subsisted largely on coffee and chocolate, occasionally defrosting treasures from my mother's kitchen.

The United States Medical Licensing Examination Step 1 is a big deal: 6h of trick multiple choice questions determine more than any other measure whether or not one gets interviewed at a residency program. Doing well means a much greater chance at getting to go somewhere I want to go for residency, and doing something that I want to do; doing poorly means that I could conceivably just get put somewhere, to become a kind of doctor I didn't really want to be. This exam has been intimidating me for over three and a half years now, and I am overjoyed at being healthy enough to have taken it on. I won't know for six weeks how well I did, but for the moment, it doesn't matter: it's over!

And now the real work begins! If the experience of my friends is to be believed, starting in January I get to pay $50k a year for the chance to be scolded for being inefficient, dangerous, and in the way. The next three years (at least) will largely be spent in sleep deficit. It will also be a period of relative social isolation. Most of the people I used to know in LA have graduated and left town. I will be on rotations with a small subset of an already small and isolated social network, and everybody is going to be stressed out in the exact same way, with nothing else to talk about. For the past few years, I've been the center of an incredibly deep and wide spring of love and support, and I have gotten used to being told by everyone around me how great I am. This coming period will be a test of my ability to maintain motivation and self-respect without the constant pats on the back that I have become so used to.

I spent today walking around the hospital with one of the Medical Student Educators, getting an orientation to clinical rotations. I have to say that despite the above, I'm pretty excited about all of this. Even though I am more dangerous now than I ever have been or ever will be, my badge opens doors with big scary signs reading "Authorized Personnel Only", I get waved to the side and told to walk around instead of through the metal detector, and I get handed tiny babies straight out of the oven. These are but insignificant indications of the humbling amount of responsibility and trust that is being placed in me. However painful the process, I realize that I am about to get an incredibly valuable education.

What I've been doing since surgery

Rest assured, no news has been Very Good News. It was a very slow recovery... until it wasn't. At a certain point I started to feel exponentially better each day, and pretty soon it became clear that I was feeling so fantastic that it was time to get back to work!

I am currently studying 12+ hours a day for the national board exam, which I take in a month. It's a big deal, and I need to focus more than I ever have before. Because of the way the timing has worked out, I have a little more time to prepare for this test than if I had not gotten sick again, which is a very good thing. My education has been quite fragmented, and I have even more loose ends and gaping holes in my knowledge than your average medical student, so I am happy to have more time to review. I have also been taking advantage of the flexibility my schedule has offered, enjoying this time of health and freedom as much as I can, considering I have to be studying full time. Here's what it has looked like! (now back to it...kidneys!)

pictures

For those of you who missed out on the gory details, here is a link to my parents' blog, where they posted the intra-operative pictures. Completely awesome if you are into that kind of thing; totally gross if you aren't! Fair warning!

Oscillon

You know that moment when you finally admit to yourself that the little scratchiness in the back of your throat isn't allergies, and it isn't because the air is dry, it's that you are about to come down with a cold? I had one of those moments at about 5am the morning of what was supposed to be my triumphant flight home to California, except that it wasn't a lame cold I had come down with. I had spent the night drenched in sweats and shaking with chills, hoping that it was all just another of the many strange side effects from the painkillers and other junk I was on. But when it didn't let up for hours on end, it was clear that these were Not Good Signs.

It was lucky that we showed up to the Sloan-Kettering Urgent Care center at 6:30am, because by a few hours later, the place was overflowing. Miserable people lined the hallways, some of their families sitting next to them on their cots, or on the floor. Such was the scene at one of the most prestigious hospitals in the world. How can this be?

Once the diarrhea started in earnest, it was pretty clear that there was no possible way that we were getting on a plane that day. And when that smell hit, there was no mistaking it: A Clostridium difficile infection. This is a pathogenic bacterium that most of us are colonized with, but which is kept in check by the commensal bugs which normally dominate. When someone who isn't in tip-top shape anyway starts taking antibiotics for some other reason, there is always a risk that the antibiotics will kill off the good gut bacteria as unintended collateral damage, leaving the door wide open for CDiff, as it is (un)affectionately known, to set up camp. And there I was, having spent the past few days legitimately, if gently, up and about enjoying New York City, once again flattened by pain and discomfort.

In more tormented moments, I felt like the rug had been pulled out from under my feet just as I had managed to stand up. In more thoughtful moments, my understanding of the vibrational nature of the universe was reinforced: The greater oscillation between sickness and health is made up of many smaller ups and downs. This was one of those small dips in an otherwise upward-sloping curve. I was going to be fine, whatever misery the little bastards managed to dish out.

We finally got on a plane last Wednesday, and I have been recovering in baby steps here in Palo Alto. I'm mostly with it these days, though I do sleep a lot, and can't be up and about for very long before I need to lie down for a few minutes. Every day is better, and I am slowly adding to a list of the things that I want to accomplish this summer before jumping into studying for the national board exams, which I will have to take sometime before beginning third year of medical school in January. I'm not sure how long I will be in Palo Alto before heading back to LA. Is it better to enjoy being with my parents, and have their support as I hunker down for the most intense studying of my life, or will I be more sane if I re-establish some independence, and be better able to study around my peers? In any case, I will definitely be taking it easy at first, as I transition out of being sick and back into being productive. There are many deep breaths to be taken, many pools to float in, many good meals to indulge (I haven't weighed 142lbs since junior year of high school!), and much catching up to do - with friends, with family, and with myself.

Success!

This is the news that we all have been waiting for!

After chopping through literally pounds of tissue extracted from my abdomen, the pathologists finally turned in their report to my oncologist, who meekly and without drama reported this afternoon that he saw no need for any further chemotherapy. The great majority of what came out was extremely dense scar tissue that required multiple changes of scalpel blades just to cut a single slice through; the rest of the tissue was almost exclusively teratoma, with a single microscopic nest of malignant cells that was completely encased within a capsule of scar tissue. This means that the pathologists are very confident that the surgeons didn't leave anything dangerous behind.

This is all an immense relief, of course! - but somehow, not unexpected. I've always known that this whole cancer thing was just a phase, and have been annoyed each time the phase prolongs itself. Move on, already! Well, it really looks like it finally has. Surgery is very different from chemotherapy. The literal physical removal of anything suspicious makes possible a different kind of hope. It can't come back, because it no longer exists!

I will probably be in New York for another week and a half. It will be a few more days before I can imagine going through the rigamarole of transcontinental travel, and I have to wait until next Wednesday for a minor outpatient surgery to remove the port that was placed in case intraperitoneal chemotherapy had been necessary. In the meantime, I am celebrating as much as my tender belly will allow.

Back in Business!

I realize that the tone of my account of the past few days differs quite a lot from that of my parents', but this fact just shows once again that we all experience the world differently. It also clearly demonstrates the fact that I am on drugs.

Considering the intensity of the surgery I just went through, I would say that the past few days have gone stunningly well. While it did take too long to find the right combination and dosage of painkillers so that I could be comfortable, ANY time at all would have been too long: pain just sucks for everyone involved, there's no way to gloss over it. In some ways it might be worse for the caregivers than the patient, when the patient doesn't feel any guilt for not being able to make it better, and when he often doesn't remember most of the pain anyway.

Same with the Fever of Unknown Origin. It definitely sucks to be soaking through pillowcase after pillowcase, but while they have to watch me moan, I get to have some pretty amazing hallucinations and other extra-ordinary experiences. For instance, I recently had the pleasure of serving as a medium via whom the spirits of some close family friends communed with their respective recently-deceased relatives. Now folks, all I am saying here is that's what it felt like when I woke up, but nonetheless, it was a pretty interesting experience that I'll bet made my afternoon quite different from everyone else's.

Personally, I think that it's the previously-diagnosed minor pneumonia that is causing the fevers, and that the antibiotics that I am already on will shortly eliminate this worry. In the meantime, my body is bouncing back amazingly well from an incredibly extensive surgery, especially considering that I just lost my spleen, which while not strictly necessary, would under normal circumstances be participating in the current fight with this minor pneumonia, a not-uncommon post-surgical outcome. I am in negligible pain with the help of a relatively small dose of long-acting MSContin, with no need so far to take the available fast-acting painkiller. I walked about a mile and a half today, absolutely smoking the competition, if I do say so myself. My cough has disappeared, I am up to 2750ml on the Inspirometer, am enjoying normal food, had a real bowel movement, and spent the day alert and chatting with old friends.

Today was an amazingly good day. Tomorrow will be even better!

Up to the minute info

For updates on how I'm doing while I am hospitalized, please see:
LiliensteinFamilyBlog.blogspot.com

Live starting in a few hours!

As I walk with my family through the New York morning on my way to the hospital, I thank you all for your well wishes and love. They are already being put to good use.

(man, am I HUNGRY!)