Its official, I have ten weeks of my electives done. There are a total of 30 weeks of elective rotations that I am required to take.  And, in these precious ten weeks I have loved each day. I can close my eyes and imagine myself as a family practice doctor. I can also close my eyes and imagine that I’m a radiologist.

I may need nine lives so I can change directions a few times. How will I ever choose?

No More (long) Family Separations:

When Casey and I were on the island we had called the St. Cloud hospital (University of Minnesota family medicine program) to ask if I could do a family medicine rotation in my home town, after my boards and, before the kids would be out of school. The alternative is that I would need to go to New York, California, or Florida, by myself, to do a few electives before my core program in Michigan would begin in July. They told us very kindly that it would not be possible. They said that because SCH (St Cloud Hospital) doesn’t have an affiliation with my medical school it wouldn’t work. I felt calm and knew I wouldn’t give up that easily.

While still an undergrad, I had been involved in a pre-med internship program through the St. Cloud hospital in which I shadowed different specialists over a one month period.  It was a valuable experience and I forged relationships with several physicians.

After completing the first 20 months of core science classes for medical school on St. Martin,  we came back to MN and I finished my boards. We had been separated for so long as a family and none of us liked the idea of me going alone to New York City, or anywhere else, for the first few rotations the  I felt compelled to ask again to do rotations at the St. Cloud Hospital. This time I had the idea to use a few of my pre-med internship relationships to make a warmer “cold call” to the family medicine director. He was so receptive and told me he thought with some extensive paperwork and a few more requests for permission up the chain of command he could help me stay. In a nutshell, I worked with a few fantastic people who really became my advocates. They worked hard to help complete the extensive legal paperwork and I was officially given a green light to do my family medicine rotation in St. Cloud. This would mean I could stay united with my family an additional four months. I’m still so grateful for their work on my behalf!

Family Medicine – Not What I Expected:

Family medicine rotation could not have been better in my wildest imagination. I showed up early to my first day of orientation with a laptop bag full of books and quick reference guides and my trusty stethoscope given to me, for my birthday, by my in-laws. The weight of the bag was light compared to the excitement, fears, anxieties and imagination going wild that were heavily besetting me. I’d just spent two years cramming my head with as many facts about anatomy, microbiology, pathology, etc. and also just successfully passed my first set of boards and yet I felt so insecure and underprepared. I said a prayer that I could rally my confidence and find it from wherever it was hiding. Being the eldest of eleven kids has blessed me with an inherent level of self-confidence, yet medical school has tested that attribute. In my introduction to clinical medicine class during my fourth semester, my professor challenged me to believe more in myself. I guess I hadn’t realized how trepidatious I appeared. Her challenge was so good for me. And, it changed my performance.  I stopped apologizing. I studied harder and believed in myself. After all, God had not brought me all this way to fail!

So, as I awaited my orientation I had all these thoughts and feelings come into my mind. I squared my shoulders and told God I’d work as hard as I could and begged for him to make up the difference.

Eight weeks went by in a flash. Some of the highlights:

In the Clinic:

I loved the diversity of family medicine. Every day brought such a variety of patients with different ages, genders, cultural backgrounds, languages and pathologies. Each day was so different from the day before. We worked extensively with Somali and Spanish interpreters and I began to get a feel for the dynamic relationships of physicians and our patients who come from so many backgrounds.

I tried to keep children giggling and be unpredictable and silly with my hiding stethoscope as I learned to conduct well-child visits.  After a child gave me trust and allowed me to examine him/her I felt elated.

I remember on one particular day, a mom was called by her daycare and told to please come pick up her child because he had a rash all over his chest. She immediately called us for an appt and brought her son in to us. I was the first to look at this “rash.” I hovered closely as I studied the pattern of the rash and tried to determine what kind of rash this could be. Possible differentials began to run through my mind when my nose perked up and alerted me that it smelled a cherry scent. I smiled and asked if her son was wearing a different shirt that she had brought him into day-care with.   She confirmed he was. I moistened a paper towel and began to wash the troublesome area away. I had diagnosed my first Kool-aid rash. This was medicine and this was fun.

In the Hospital:

In addition to seeing patients in the clinic, I also spent time in the hospital as well.  When patients of the family clinic are hospitalized, the family docs are still their primary care physicians, and are the first line of support while they are hospitalized.

This hospital treats their students like doctors. We had full access to the Physicians Lounge where free lunches were available everyday. Delicious meals. And breakfast and dinner, too. What a deal! They treated us so well here. Often during our lunch we had a seminar with a keynote speaker. Lectures on Alzheimer’s disease, how to know when to refer a patient for hyperbaric oxygen treatments, ENT do’s and don’ts, how to do a teen physical, Tuberculosis awareness, etc.etc., we took turns and answered practice board questions and discussed our answers. This was a great opportunity to continue to increase my medical knowledge.

One of my first hospitalized patients was a man who had come in with extensive constipation. I spent several days becoming acquainted with him and his wife. They shared many details of their lives and I became very fond of the couple in the process.   He had used some painkillers for a medical problem for which he had recently been treated, and unfortunately these pain-alleviating meds had sufficiently stopped him up and he was miserable. This is my first encounter being SO GRATEFUL for awesome nurses. The words “enema” and “fecal impaction” were being tossed around and I’d heard stories about physician’s rights-of-passage. I was determined to help where I was needed– if I was asked. I wasn’t asked, and I didn’t volunteer. In hindsight, I felt a little guilty leaving it to the most amazing nurse ever. I rationalized that I will have plenty of chances perfecting my enemas and fecal impactions when I rotate in internal medicine. She gave him the necessary care to unstop him–and she did it with a smile. I’m in awe of nurses.

An especially enjoyable highlight was being part of the labor and delivery of five babies including several c-sections. During one particularly difficult labor, I almost passed out. How humbling it was that I needed to go and put my head between my knees and breathe. Several nurses came to attend to me in the hallway: they brought graham crackers and orange juice and I felt so, SO, ridiculous. I hope that young, new mom, will forgive the new med-student for upstaging her for a little while.

I had my first patient die while in the care of our team. She had come into the ICU so sick. She had a breathing tube and many monitors attached to her body which let us know that with each passing day her condition was worsening. There were many tones and alarms alerting us that her stats were not within healthy range. Her heart, her lungs, her entire body was struggling to hold onto life.  Each day her lab values would worsen and each day I’d hope she would pull through. Just before she died I met with her family and we talked to them about her prognosis. I felt so sad. I wish we could save everyone.

Code blue means cardiac arrest. To me, it means every student and resident runs to the patient’s room to learn, by watching the pros, how to take care of someone in cardiac arrest. I stood completely squashed in the corner, with my adrenaline surging, straining to hear what medicines they were pushing, on my tippy-toes so I could see as much as was possible. I beheld a few doctors and nurses ever so methodically bring a woman’s heartbeat back. They didn’t panic. And they succeeded. It was amazing.

Honing my clinical skills and ability to diagnose comes with experience and lots of practice. One day, my resident gave me a brief history on a woman who had recently lost a lot of weight, she was having intermittent fevers, and felt very tired. She recently had some dental work done and I had a pretty good idea what was wrong with her. It was a textbook cardiomyopathy. A bug from her dental work managed to colonize in her blood and was able to take residence on her heart valves. Sure enough she had a new heart murmur, she had brown spots of her fingernails called Janeway Lesions. We did an echocardiogram and some labs to confirm. This was just like I’d learned in pathology.

I went to medical school with the strong inclination to go into oncology. So, when I had the opportunity to attend two cancer conferences I was eager to see how the fit would be for me. Each of our patients were terminally ill. We extended conference calls to family members and placed many chairs around the patient’s room.  As I watched each chair fill with children and beloved family members my heart began to swell. I became more aware what an honor it is to be in medicine and be allowed to share these last precious moments with our patients and their families. I witnessed the love of a lifetime being shown, it was so palpable.  I hadn’t even met these patients before the conferences and yet some of the tears being shed belonged to me. I tried to be inconspicuous and wipe them away. I focused on squeezing my right hand with my left behind my back to distract me from my overwhelming feelings.  How do I think I’m going to be able to do this speciality?!;)

Working with the Residents:

The family medicine residents with whom I worked were fantastic. They came from all over the world and each had such a unique way of caring for their patients. I tried to take some of my favorite interactions and add them to my dr. bag of tricks.

There was a resident who would often pimp me on my math skills.  He was prepping a prescription and asked me what half of 118 was…I became a deer in the headlights. A little over 60…yeah, 63?! oh geez!! I was unable to calculate his advanced problem.  I wanted to crawl in a hole and stay there–forever! In the middle of the night, I woke up to my brain telling me that half of 118 is 59. I had to laugh at myself. Better late than never? Getting a grip on nerves is key for success. I’m still working on it.

I asked another resident if he could teach me how to do IVs. He volunteered to be my guinea pig. So, we went into a clinical room with several IV kits and he was very tolerant as I jabbed him with needles and repeatedly failed. I have taken for granted these skills in the very competent abilities of the health care professionals in my life. These are not easy skills. And when you become nervous and your hand shakes, that is not helpful.  By the time I’d blown through more than a few of his veins we called it a good start. He was kind and said we needed a nurse who has better teaching skills. But, in the meantime, he proceeded to place band aids all over his hands and arms, and a few on his face just to be dramatic. He looked like such a pathetic victim when we emerged from the clinical room. Once again, I ate some humble pie and vowed I’d never forget this feeling. So, someday when I can quickly and successfully begin an IV, I’ll have more mercy on a beginner like me.

Each morning on rounds with the attending physicians, the residents and students would “present our patients.”  The perfect way to do this is very methodical and organized. Its a lot of pertinent information about our patient and their care. My goodness how my beginner’s jitters can make that information come out a jumbled mess. I’m so grateful for all the residents and attendings who patiently counseled me as I trained my nerves to stay in their place and helped my presentation become, painfully and slowly, a little better each day.

I danced with the residents. What? Yep, that’s right. I had overnight call every week. 28 hour shifts were new to me. And, sometimes when things were slow we’d play music and dance. You can’t take life too seriously. It’s late and were are on call. How else were we gonna stay so jazzed up til our next patient comes? 😉

I loved family medicine. A sample of each specialty all in one.  I enjoyed spending time with patients and developing relationships with them and their families. Several of them with whom I helped make a difference in their care requested my contact information so they could keep in contact — what an awesome feeling!


My next rotation was radiology. Prior to my first day, I envisioned this rotation as an entirety of hanging out in dark room with lots and lots of CT scans, MRIs, and x-rays. I was so wrong. I was able to travel to some rural hospitals and witness some amazing, cutting-edge medicine.

Some highlights:

Set the background here:  When many women age they develop a weakening in their bones that is conducive to bone compression fractures in their spines. We had several patients that came in with excruciating pain because of this type of injury. Listen to this, in radiology they can use some very hi-tech equipment and visualizing tools to inject a special cement into a spinal compression fracture and fix them. During the procedure I could see the doctor carefully inserting a cannula into the vertebrae with the spine so cozily positioned near by, and if that didn’t make you nervous, the aorta feeding life-blood hovering near-by as well.  My blood was pumping, what a rush. The need for exactness is so crucial. More than once we had our patients come in with a 20 out of 10 on the pain scale (people in pain tend to max out the scale) and post procedure their pain becomes a zero. Its absolutely amazing.

Some other procedures I observed were how to place a pic line, how to do a lumbar puncture, how to do epidural injections, how to do paracentesis and take fluid out of a  patient’s belly, how to do thoracentesis and take fluid from a patient’s lungs, how to do a swallow test, how to read x-rays (watching for fat-pad signs, joint space maintenance, air where is shouldn’t be, learning the colors of fat, muscle, bone, and water, and the list goes on and on. I’m in awe at the profound details that the physician In shadowing I was able to see and how quickly he could pick up on something not being right.  PRACTICE, PRACTICE, PRACTICE. I was able to look for dislocations and fractures, and for osteoporosis. I learned to appreciate the reading of a PET scan to monitor the progress of cancer treatments.

I worked on my CT and MRI reading skills. I can now tell you where the spleen is located. I learned some key points about how to watch for dangerous time-sensitive diagnoses.

In a nutshell, It was awesome. I would love to be a radiologist too:)

So my first 10 weeks are done:

I’ve just begun my Psychiatric rotation in Michigan. The weeks are flying by, and aside from missing my family right now, I’m loving every minute of it!




Note from Casey:

It’s Wednesday, August 13th, 2014.  The house is chaos as the kids and I get ready to move to Michigan in 1.5 days.  Carina’s mother and some women from church are here helping with the final stages of packing. Andi and Tanner have been working *hard* at packing during the day while I’ve been at my full time job (I work from home), and then we have all worked together in the evenings as well.  Those two are champs, and deserve a HURAH!  for all of their incredible hard work the last two weeks.

We are proud of Mom and all of her hard work in Michigan, including all the time she has invested finding a place for us to live after already putting in a long day of Psych.  We are ALL ready to be back together after 5+ weeks of being apart.

Yet another chapter closes, and a new one begins.


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    Rebecca commented

    Wonderful detail about the patients and your feelings. Thank you so much for sharing this! =D

    August 14, 2014 at 1:38 am
    Emily Taylor commented

    Thanks for the update! It’s so fun to hear about all that’s going on. Best of luck with the move.

    August 15, 2014 at 6:28 pm
    Cookie3521 commented


    Did you already graduate from AUC? Did you get MATCHed? I got accepted to AUC September 2016 class.I am not a US citizen, however I completed my bachelor’s in US and wanted to practice in US as my husband stays here. Do you know of any friends at AUC who are on the same board with me and still got residency? I am so worried about my chances of being placed in residency after graduation. Can you please give me some insight?


    December 11, 2015 at 3:33 pm
      Casey Crookston commented

      Hello, and thanks for the comment! Yes, my wife did graduate from AUC. She would have matched this March (of 2016) but she was offered a pre-match, and she started January 1st. To answer your question, there are a fair number of non US citizens who are students at AUC. And during rotations, my wife worked with several non US citizens who were already in residency. That being said, please don’t take my word for it. You’ll still need to do your own due diligence and make sure that your green card or your visa will allow you to live in the US and participate in the match process. Good luck!

      January 20, 2016 at 8:31 pm

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