Hey everyone.. it's been a long time since my last entry and I'm happy to announce I finished and survived third year! It's amazing how time flies when you are having fun.. and kind of stressed. :) 

In celebration of finishing M3 year and prior to starting M4 year, I traveled to Panama with my boyfriend to see my family, friends, and of course, dogs.  I love having visitors because it gives me an excuse to be a cheesy tourist (minus socks and sandals of course)! And don't worry, I took lots of pictures. Panama Canal? Check! Old Panama and Casco Viejo? Check!

Leaving home was incredibly difficult after that exciting week, but it was time to get back to reality! I returned to Ann Arbor and began M4 year in the Medicine Critical Care Unit. It was also my first month as a sub-I, which essentially means I'm an intern in training with more hours and responsibilities compared to before, plus I report directly to the senior resident. I love the new role, but it has also given me a lot to reflect on in terms of life and death issues. Walking through the ICU, it's hard to ignore the multiple tear streaked faces and groups of family huddled around a loved one. Within my first two weeks, I unfortunately lost 3 patients. Some of these losses were unexpected, but most came after many years of struggling with a chronic, debilitating disease. Family meetings to discuss goals of care conversations (ie escalating care with no benefit vs comfort care) were difficult but necessary. I can now see the immense value in making a patient comfortable as they spend the little time left with loved ones. This does not mean a patient has "given up," instead its a matter of enjoying the life they have left instead of being poked and prodded in a hospital bed surrounded by strangers and hospital equipment. Just because we can do invasive and advanced medical interventions, does not mean it is always for the best of the patient and their ultimate goals, thus goals of care conversations are essential.

Even with the stress and long hours of the ICU, I'll be taking some time to enjoy beautiful and sunny Ann Arbor. Summer is a season filled with wonderful street fairs, restaurant week, and outside cafes and food carts! I'll keep you all updated on the mini-breaks I take to enjoy the season!

Take care!

Hema