Anyone else hit overwhelm?

I have. It is frightening.
Lack of sleep is starting to occur too. I feel like I am always behind or not up enough to spout off every freaking mechanism to cardiac function known to man. We cover one chapter a day in Biochem and then 2 in Neuroscience.
Fortunately, there are no tall buildings in this podunk town I am in.

Yup. Just one more midterm to go, in neuro.
Here at UMN-TC, we have class in the tallest building on campus. But in the basement.
You are not alone in this.

Yeah, of course we’re overwhelmed. It’s med school, isn’t it? The first semester here went so smoothly, I almost forgot that it was supposed to be overwhelming. But let me tell you, they’ve made up for it this semester!!
Just hold on to the fact that there are only a few months of year one left. We’re better than half-way through!!

One of the great, exhilarating things about medical school is that you run into these periods… and you get through them and you realize you have done it, just as well as any of your classmates (well, okay, there’s always someone who is WAY better but there are also folks who are struggling WAY more than you).
In third year, you’ll discover that just about the time you figure out the “rules” of a rotation, and actually get comfortable with what you’re doing, it’s time to switch to something else. Medical school is pretty much about being constantly off-balance and feeling like you can never know enough.
Your reward is fourth year, elective time, residency interviews, and lots of vacation time! I realized today that I only have to wear my incredibly grubby short “white” coat for two more weeks, yeah! After that i’ve got two classroom weeks, then a big chunk o’ vacation, then some more classroom and graduation. Wooo-hoooo!

I am not at your level yet but can relate to the feeling – for whatever it’s worth I think you all rock.

It just seems like if you are there, then the smallest little thing can make you crack. You are studying and then a dog comes over to get petted and knocks your papers all over the floor and you just want to sit there and scream. You take 15 minutes to reassemble everything and then realize how late it is and that you are falling hopelessly into some vortex-like black hole. It seems endless.
We covered the final elements of Cardiac systems on Friday and he scheduled a special session on Wednesday to cover Lead Placement and ACLS information, blah blah blah. It just doesn’t end. I had Wednesday pegged as a special luncheon for Debbie and I as well. There goes that plan all shot to hell. I’ll need to be there for it since it is on the boards and I need to know it.
Lost in Luton…

I can relate to that – take a deep breath. You’ll get through this.

Hi there,
To all you folks on overload: When it comes down to the final cut, you just can’t learn it all. You are going to reach a compromise with yourself and the material that will enable you to feel less compelled and driven. I promise you that you will get several opportunities to master some of the small details that elude you on the first go around.
I still spend a couple of hours each day reviewing cell biology (you have to understand integrins and cells to understand how wounds heal), pharmacology (there are new pharmaceuticals released each day and you have to totally understand anything that goes into your patients). I am also reviewing pain pathways and autonomics constantly because of my role in the intensive care units.
Last evening, we lost a very young patient to massive blood loss. If you see how the body responds and understand that response, it helps you to understand why you have to get into the abdomen and get that aorta cross-clamped as quickly as possible. You have to have good vascular access and you have to have four people literally squeezing fluid into these patients to have even a small chance at survival. It was tense but a learning experience for all of us after the situation was over.
Think about the feelings that you have now and find out how to work through them. Even the most difficult job, under the most extreme conditions is chipped away one task at a time. Consider this “overwhelm” feeling as practice for when you are in the trenches and actions have to be done. You are going to be forged and ready. One of my professors is fond of saying,“Surgeons are not made, they are forged”. I remind myself of this after 24-hours of constant output. I did some good stuff in the last 24-hours and I could have performed better in other stuff. In the end, I am at peace with myself because each experience makes me stronger.
Keep plugging away even if it is one sentence at a time.

I am halfway through my first 6-week stint as a resident in the ICU. Even though I have logged many a year & many an hour in ICUs - doing so as “the physician on call” is a beast of a different color! Every shift I pull, esp when I am feeling like I cannot cover anything more, I try to sit a brief moment to ponder what am I doing well, not so well & how can I push myself to do even better. After each shift, I pointedly replay my clinical decisions & processing - putting it all through the most intense scrutiny I can muster. Furthermore, I ask the ICU fellows & attendings to provide honest & constructive criticism…I generally & politely reject the “you did fine/well” and ask for real feedback, admitting that I am only an intern & it’s impossible to be ‘good’ at this level & the only way for me to grow as a physician is with their earnest input.
It is the drive to excel tempered with confidence to know your limits & how/when to push the envelope that can only come with maturity that will propel us to become excellent physicians.

And it’s funny, but Joe said that you’re just starting to feel fine and something happens that seems to make everything fall apart again. Well, that may be true.
But on the other side. Just when you think you’re at wits end, and you’re so frustrated you feel like pulling your hair out. . . that’s when something might happen that makes you smile. . . . For instance, for me it meant I passed my second anatomy exam, much better than the first one (which was barely a 70 after challenges. . and only 70 because you round fractions up)! Or maybe it was my doctor telling me that I will get out of this wheelchair. It might take a couple more weeks or even months, but when I get out of it, my trochanteric bursa will be completely healed. Or maybe it was the OMT doc who told me my smile looked more like my normal smile, the one I had before I got the bursitis. .
So, even though a lot of things are still putting pressure on me, I find relief and satisfaction in the positive little things. …
Keep the faith everybody. And maintain your determination to do well and your dedication to learning! After all, that’s what medicine and being a doctor is all about!

But Nat, I have a question here. If you cross clamp the aorta, will you not, depending on the location of the clamp, cause a backup toward the heart so that even temporarily you cause LVH. Does this not then increase pressure on the LV and then start a systemic downward spiral? I realize that there are many shunts which the blood can go to and I am thinking mainly of the aortic bifurcation at T12 which would also harm the muscular tissues in the legs over the long term.
Any surgical response would be welcomed…

Hi there,
The idea is to keep the brain perfused during a massive hemorrhage. If the patient is bleeding out, in my case both the aorta and the IVC were transected near the bifurcation of the iliacs, I have to keep the brain alive. I would have loved to worry about LVH in this case. It would have meant that I would have enough time to effect some kind of repair. As the case stood, there was too much hemorrhage and not enough blood circulating centrally. In a severe trauma, you always go ABCs. With Airway, Breathing and then Circulation. We had the A and B but we were not even close to having the C. If we had enough central circulation, we could have packed until we could have effected a repair but as it stood, the patient had lost most of their blood volume into the lower abdomen and left the heart empty. Again, I wished that there had been enough blood to cause backup but that just wasn’t the case. It was all in the abdomen and pelvis. It was also tracking down into both thighs. You can put 3,000ccs into each thigh. In the average person, 3,000cc x 2 thighs equals most of your blood volume gone where it doesn’t exchange.
Even with a ruptured abdominal aortic aneurysm, the first thing that you do, after getting into the abdomen is cross clamp the aorta to keep blood circulating centrally. Often these folks end up with “boxed” kidneys and intestinal ischemia. These are not pretty cases but when you save one, you have to have everything fall into place. There is a 85% mortality even in the patients who get to the hospital. Most of these folks die before reaching the hospital. These are great cases and can stretch your skills. Add a transection of the IVC and you are facing an uphill battle. Think about how much time it takes to squeeze a unit of blood into a patient. With four central lines, two in subclavian and two in the groins, you can only squeeze four units or four bags of crystalloid at a time. A completely transected aorta is almost 100% fatal. Add a transected IVC and a very tortuous track of the bullet and you have an uphill battle. This case made me long for the days when life was simple. This was a very young person whose death was totally preventable.

Thanks for the reply. I was thinking NORMAL reponse with no bleeding or very little given a small hemorrhage. Given the trauma as described, I can see where there was little ability to reperfuse the thoracic cavity let alone the rest of the body.
You obviously did what you could.


"he scheduled a special session on Wednesday to cover Lead Placement and ACLS information"

Yo, Joe!
What the hell kind of school are you going to?! That sounds like practical, useful information they’re teaching you. How dare they? Don’t they know they’re not supposed to teach you anything you can actually USE during the first two years?
Take care,
PS, don’t mind me, I’m just feeling particularly sarcastic tonight. There really is useful information, it would just ruin the joke if I admitted it right up front.

Yo Jeff, someone forgot to hand him the memo.
BTW, I have had a bad headache since…well, the last time I was with you.
How goes 3rd year?