From Mom Brain to Medicine Brain

Over this past month, I have transitioned into the world of finding an equilibrium between mom brain and medicine brain.  I have struggled with my self-doubts and guilt of wondering how might I find a healthy equilibrium between being the best “Leo’s mama” I can be, and fulfill my dream of becoming a bright, committed family physician.  My one-year of maternity leave with the mighty, 10-month old Leonardo Robert, has taught me a whole new level of adaptability, perseverance, compassion, love, and understanding, all of which I attribute as assets in my daily practice as a student doctor.  Perseverance and love have given me the strength to continue on in this transition of weaning from a 100% selfless, vulnerability as a “stay at home mom,” back into the compassionate, committed future physician that I have strived to become over these past 6 years of medical school training.

On July 3, I said “see-you-later” to my son and partner, Ernesto, at our home in Cuba, so that I may return to San Francisco for a 1-month internal medicine clerkship at St. Luke’s Hospital.  My brain has been “jump-started” back into the mind-set of using evidence-based, clinical medicine, guided by my heart that is full of an unconditional love and compassion that could only be formed by my experience as Leo’s mama.  Of course, my brain has needed a little bit more massaging in order to get back on the level and pace of thinking like a physician, but I will always be humbled by my experience as being a full-time mama during my time off from medical school.  During these past three weeks, I have been reassured that I still have the capacity to function in a U.S. clinical setting, yet with a whole new understanding of the compassion necessary to cure sometimes and care all of the time, as a physician.

In a couple of weeks, I will travel back to Cuba, prepared to persevere through my 6^th, and final, year of medical school, looking forward to July 2016 in which I may officially change my title to Sarah Janelle Hernandez, M.D.

Mama Doc

Hola!  Many of you do not know me yet, but you know my soon-to-be-mama, Sarah.  Surprise!  I am Leonardo Robert.  Here is a recent photo of me taken during my last ultrasound.  Although my mama is super comforted to know that I have grown and developed into a big, beautiful baby boy, I think she is still trying to process my weighing approximately 8.5 to 9 pounds as I travel through her birth canal.
This past year, obviously, has been super adventurous for my mama.  She managed to finish her second-to-last year of clinical rotations (5th year), and study for and take her last two medical licensing exams.  Please keep in mind that she did all of this while toting me along for the ride, continuing to demonstrate her commitment of becoming a physician.  Since my expected arrival date is October 5 (my mom's birthday), my mom decided it would be best to take a year off of medical school for maternity leave.  It will be so nice to have some quality mama-baby time.  Don't worry.  She will commence her last ten months of medical school rotations in August of 2015.  Now, she gets to do it with a loving family in tote.  My mama will have so many new tales to share with you as a mama doc, raising a Cuban-American baby in Cuba, all the meanwhile finishing her Cuban medical school education.  For now, she and I are nesting in El Paso, TX, preparing for my soon-to-be-arrival.  My mama feels so blessed to have friends and family located all over the country and world; however, that fact makes it very difficult to plan the traditional baby shower.  But, when has anything in her life been "traditional?"  There is a party planned for September 7, here, in El Paso, but that makes it practically impossible for all of you to celebrate in person with us.  She is hoping that you may assist her in preparing for my arrival by purchasing some much needed items from our baby registry at amazon.com.  Here is the link: http://www.amazon.com/registry/baby/1EVHGIXG1UEED.  I am very much looking forward to meeting you, and of course my mama will keep you posted.  

The ants come falling one by one...

The ants came falling one-by-one one this particular super-hot, sweat-mustache, chest condensation provoking afternoon in June, as one of my cohorts and I attempted to sit outside on a bench to begin preparing for the U.S. clinical skills board exam that we will be taking at the end of this summer/fall.  What would seem completely abnormal to many of you all was just a shrug off the shoulder to us.  My cohort and I were sitting outside on this bench, under the shade of the trees, yearning for any breeze that would cool us off from the afternoon heat and humidity of Cuba, practicing doing a history and physical exam on each other when we kept noticing ants crawling all over each of us.  The ants came falling one by one from the same tree that was providing us the shade.  Well, then these ants began biting us in the most personal areas that someone could be bitten in.  And these are not those nice, just minding my own business looking for my next source of sugar ants.  These were flesh biting ants that once you are bitten you become victim to an intermittent burning/stinging/itching pain that can linger for hours.  Yes, they are the tiniest little assholes.  But, the afternoon just kept getting better and better as we continued on practicing our physical exam under the watchful eyes of two Cuban men sanding the body of their door-less 1952 Dodge.  There was plenty of opportunity for us to be stared at since only one of them could work at a time, while the other one took turns watching what his buddy was doing and of course checking us out.  But, you know…they only had one piece of sand paper to share between the two of them, so it would make sense that one would do the work while the other one watched, and of course the one that would watch would become so fatigued that he would have to regain his strength by laying down and taking sips from the rum bottle.  So yeah…this is not your typical study environment, but this is our typical study environment.  So many stories to share that have become so mundane in my Cuban life.  Eventually, Evelyn and I just fell over from laughter in tears analyzing how “not normal” this is.  We should just automatically pass this board exam due to persevering in our studies during the most adverse daily living situations. 

Changing channels, time-warping from 1959 to August 2013: my journey continues after finishing a 4-week rotation in the hospital wards of Highland Hospital in Oakland, and now scrambling and pushing myself by studying for that clinical skills board exam that I will be taking before I head back to Cuba in the beginning of September.  Overall, I found my time on the Highland wards to be very challenging yet rewarding.   Although I felt some of the systematic challenges of using electronic medical records and more advanced technology, and of course just getting used to Highland during my first week on the wards, overall I found it refreshing to be able to do my job with more resources than I am used to in Cuba.  I felt that my Cuban education's strengths in emphasizing history and physical exam served me well on the wards at Highland.  And of course, being a fluent Spanish speaker (another reason to be grateful to my Cuban medical education) not only served my patients, but the team's patients as well.  I cared for patients with social determinants that I never have had to face while caring for patients in Cuba, like homelessness, drug addiction, HIV/AIDS, etc, patients coming to the ED, for example with shortness of breath, then being admitted and having to manage all of their preventable, chronic diseases in an in-patient setting.  It became so apparent to me how essential access to compassionate, comprehensive healthcare is.  It just does not make any sense to me that we cannot accomplish this here in the U.S. where we have such an abundance of resources.  My compassion for my patients and medicine motivated me to get through every challenge I faced during my time at Highland.  I came out of that experience of working 12 to 13 hour days more confident of my ability to function in a U.S clinical setting as a soon-to-be physician, fortunate to be able to start giving back to my under-served communities back here in the U.S. 

So, my summer “break” is coming to an end and I realize that it is that time again in which I am asking for suitcase love to send me back with on my journey to medical school in Cuba. Just think...it's my SECOND TO LAST TIME I will be sending out such request.  I cannot express enough gratitude for all of your love and support over these past 4 ½ years.  Here is the link to my amazon.com wish list if you are able to assist me in filling my suitcase: http://amzn.com/w/1FRMSH7O5SV3I. Much love!

Love in the Time of Cholera

Once upon a time, there was a future-physician studying in a land where everything appeared to be like she had traveled back in time to 1959.  She had once promised herself that she would never fall in love with a man from this land, but out of nowhere, the thrill of love blind-sided her.  Some characters in this land have referred to this true-story as unbelievable, because chapter by chapter, it seems as though all events could only appear in a Mexican telenovela; however, chapter by chapter this story is real, as real as the recent cholera epidemic in Cuba.  Just as cholera can be overwhelming with its voluminous rice-water diarrhea, this love was as overwhelming as hurting-so-good.

This man was no ordinary man, he was her dream man--incredibly funny, intelligent, super-fun and adventurous, kept her on her toes, introduced to her the amazing Habana night-life of music and dance that she had always yearned to know, and turns out to be the chef that she, at the age of 11, told her mom that she would one day meet and fall in love with so that she would never have to cook again.  Most of all, he made her feel like the sexiest, most beautiful, most incredible woman he had ever met and once said that he would like to end his days with her.  However, the real base of the story plot  of this soap opera began a short time before she met this man.  Not too much time beforehand, this man suffered from what it is like to be presumed guilty until proven innocent under the court of law that governs this land (not presumed innocent until proven guilty like the law that governs my home-land), his whole life torn out beneath him, a life that was once full of the luxuries of this land.  Once the law that governs this land had its way with him, they released him into a life in which he would be forced to sacrifice his true happiness.  Left in the profound slumps, he would soon find light at the end of the tunnel, with a promise to escape this land by marrying a stranger from Poland in hopes of building a new future. And, now steps in this sexy, beautiful, intelligent future physician, their meeting was purely by fate and was what he referred to as true happiness because he had never met anyone like her. Chapter by chapter, the soap opera continued, full of promises and hopes that they would spend their lives together, up until the stranger-wife would pop up in the story because you know…their story-line would pause so that he could maintain his other story with stranger-wife, motivated out of pure self-survival. Chapter by chapter, the soap opera unravels, up until the moment when she began to recognize that she was beginning to lose a little part of herself, the same part of her that everyone who meets her is drawn to. That bright Sarah-smile began to be replaced more and more with a face of worry, worry that her man would soon be leaving her to fulfill his promise to stranger-wife, but always leaving her with some false-reassurance that upon leaving her he would return to her in the future. And, the last chapter of this soap opera comes to an end as this beautiful, sexy, intelligent, future physician realized that she would no longer sacrifice those moments free of worry and self-doubt, that her happiness could not be determined by the promises of this man. Just as she learned to mandate prophylactic treatment for cholera as she walked the streets of this land of 1959 for a week, she also learned that there is prophylactic treatment from a life enveloped in a made for television soap opera just as overwhelming as the voluminous rice-water diarrhea of cholera.  He just plain should have not f*&ked with her, because sure enough she picked up the telephone and called stranger-wife.  Poof be gone…exit-visa with stranger-wife!  The end.

Cuban Suitcase Love and Medical Board Exam Update

So, I am writing, first, to give you an update on this mind-humping task of studying for my medical board exam aka USMLE Step 1, and second, to ask my annual favor of assisting me in filling-my suitcase to serve another year of my 6.5 year prison sentence, I mean medical school education.
For these past eight-weeks, I have faced one of the most difficult challenges of my life, more of an obstacle to becoming a physician. The national medical examining board unbelievably accepts around 65% of correct answers as passing.  I have never hoped and prayed to get a 65% ever in all of my of schooling, but as I go into robot-mode sitting through the 8-hour exam consisting of 322 questions, all against the clock, yes…I will be hoping to get 65% of these mind-humping questions correct. I imagine myself coming out of the exam with some form of post traumatic stress disorder, lying on the sidewalk in the fetal position, sobbing out of relief, or maybe just unresponsive.  Mom, just be prepared to retrieve an inebriated child after the exam. The pressure is on, grateful to have the voices of my Cuban professors telling me what the right answer is in the back of my mind.  Educated guessing, as I call it seems to be in my favor. Repetition is key in conforming my brain to the national board of medical examiner’s standards of quality.  Oh believe me, putting in 12-hour study days, training my mind and body for this marathon of an exam has not been easy. Thank you to all who have been praying for me, snapping me out of my break-down moments, and cheering me on through this process--especially, my mom who has tolerated a not-so-normal Sarah these past 8 weeks.  I feel like somehow everything is coming together as I head into the final stretch.  Yesterday, I sat through a 4-hour practice exam at the testing center, and passed.  By this time next week, I hope to have closed this chapter, celebrating with my dearest friends and family whom I have neglected for these past 8 weeks.
I plan to travel back to Cuba on October 7, and I am hoping that you can help me with some suitcase love.  I am including a link to my wish list from amazon.com.  http://amzn.com/w/1FRMSH7O5SV3I This summer, I am requesting a few books, but as you can see I have quite a list of toiletries and I am in need a new school uniform.  My others are 3.5 years old. Gross, as you can imagine 3.5 years of hospital cooties, amongst my own that accumulate in the hot, humid climate of the Cuban streets.  Honestly, if I did not need these items I would not be requesting them. And please, if you do purchase something, request a gift receipt.  I was so upset to learn last year that I was not receiving purchaser information with the orders so I was unable to properly thank the gifters.  I sincerely apologize if any of you did not receive a proper thank you from me for your donations.  I am always super grateful and will make sure that you receive a special thank you note.  As my favorite gun-totin' judge in Northern Nevada puts it, "shed a little karma."

History is written

‎4,500 words of an excerpt from my history, written by presidential historian Anthony Bergen. Thank you for the hysterical laughs and unexpected tears. http://deadpresidents.tumblr.com/post/27719109313/sarita-de-la-habana

And I know it is to time to come “home” when…

…the mangoes grow to be the size of my head, when I can no longer tolerate the feeling of a sweat mustache and chest condensation from the intolerable heat and humidity.  Yes, mangoes and sweat mustache, I must come back to Ahmurica in order to prepare for my STEP 1 exam, yeah…you know that exam that I have been studying for the past nine months for, amongst having to study for internal medicine and working at the hospital, doing long on-call nights in neurology.  The exam that was forever looming in my conscience, the conscience that would push me to stay in and study on many Friday and Saturday evenings, when all I desired to do was go out and play in the streets of Habana.  Oh yes…that is the one…that 8 hour/$800 exam that I only want to take once. So yes, I arrive back to the U.S. to mount up for 10-12 hour study days, as I prepare to take my first board exam at the end of August. This is 4^th quarter, baby.  I am mentally, physically, and emotionally exhausted, but I keep on carrying on. Thank goodness for thoughts of fueling myself with Peet’s coffee, having unlimited access to wi-fi, and of course having my dearest family and friends within a phone call or brief visit away, cheering me on to push me through the end of the game.

I am closing the chapter of the longest/shortest year of medical school ever.  I say longest, because I thought it would never end, but the shortest because somehow it went by incredibly fast, but I think I was just more or less distracted by everything that I learned, learned about medicine and myself, the amount of character I have built in extremely challenging circumstances, continuing on when a part of me wanted to say “f*&k it.”  Mostly, I learned from my patients in the geriatrics ward.  They taught me life lessons, just by listening to them, to their histories.  I learned more of what love is, how to overcome struggle with integrity and grace, to learn the importance of listening and knowing the histories of my patients as a compassionate human being.  I was in midst of true revolutionaries, “combatientes.”  Every patient has his/her history, and if physicians and other healthcare professionals take the time to truly listen to their patients we can all know part of what makes them who they are—how their life circumstances, or histories, form the human being who sits in front of us, trusting us, welcoming us to bring some type of healing to their life.  Señora Juana, my incredibly sweet, strong, resilient, 74-year old patient, whom I discover has been married (and still feels in love) to her husband for 52 years.  Señora Juana has known her husband for 60 years, however tells me that she did not see him for 6 years because “well you know…he was in the Sierras, but you know I was waiting for him when he and all the others came back into Habana.” I asked her, “The Sierras? As in the Sierra Maestras? Like with Fidel, Che, and Camilo?” She simply replies to me, “Yes…”  I was like what the heck?!  Her husband was in the mountains of Cuba, guerilla fighting during the revolution, and she was there in the famous scene where Fidel, Che, and the other young Cubans marched triumphantly into La Habana, waiting there for the love her life after 6 years of him being away fighting.  After examining her one morning, I said see you later to her and her daughter (who brought me a morning snack every day), we hugged each other and she lightly caressed my head in the temporal region, and told me what a good doctor that I am/will be.  That was the last time I saw her.  She passed away that evening.  I cried that following morning.  Then, there is another bad-ass revolutionary, whom I found out just by talking with him that he was also a “combatiente” en las Sierras.  His son brought photos to show me.  This guy, was 19 years old, guerilla beard, military fatigues, holding a rifle, amongst the other young revolutionaries, in the Sierras--young men and women, fighting for their people.  The next photo he shows me is of him coming out of the top of the tank triumphantly, with Fidel at the Bay of Pigs. All I could do was express to him, in awe and gratitude, what a grand part of world history he was a part of and sincerely thank him for all of his sacrifices, because without him and the other young revolutionaries I would not be studying medicine in Cuba.

                                                                                                                                                

And then there is Señor Eloy, whom managed La Bodequita del Medio for decades (made famous for their mojitos by Ernest Hemingway), who was good friends with Hemingway and shared with me, amongst other stories, what a drunk and a jack-ass Hemingway was.  He showed me exactly how he would stand over the bar, wobbling just like an old drunk man. Hahahaha.  Señor Eloy, I will forever cherish the mint leaf masher you gave me before you checked out of the hospital.  I will think of you always, especially when I am an old lady showing off my mojito making skills to anyone willing to take my mojitos-on.  Thank you for teaching me to never take love for granted, that I must live every day and love as if it could be my last, to not worry about tomorrow, but to live in the moment that I am in.  And…I will see you when I return to Cuba in October, to start my 4^th year of medical school, to take you up on that offer of dinner at your family’s home, so that I may continue the celebration with you and your family.