blame it on the kids

HPI: female medical student with sore throat x 3 days, non-productive cough developing over last 24 hours along with hoarse voice and headache, possibly a subjective fever
sick contacts- numerous kids with strep, RSV and all other sorts of viruses seen and examined in the last week courtesy of her time spent in the Peds ER
cough drops and Advil has been mildly effective. no change in appetite. recent difficulty sleeping due to nasal discharge and cough.

PE: pt looks tired and miserable but not that sick. throat is mildly erythematous and adenoids are visible but without purulent discharge. cervical LNs tender.

DDx:
URI/Laryngitits- unspecified viral, top contenders include:

• Rhinoviruses
• Parainfluenza viruses
• Respiratory syncytial virus
• Adenoviruses
• Influenza viruses

Steptococcal Pharyngitis - (pt has had strep throat no less that 50 billion times in her life and blames her sensorineural hearing loss on all the antibiotics she took as a kid trying to get rid of the same. pt can swallow without too much difficulty and lack of real fever, appearance of the throat are less suggestive of this dx)


A/P: Most likely viral so therefore no treatment warranted.

Rx: Take the morning off to stay home, drink tea and study. (Pt would not want to get the healthy kids coming for well-visits sick, after all!)

10 fingers, 10 toes...

I just finished my two weeks of inpatient floor work and next I have a full week of newborn nursery. We had an intro lecture on Thursday and I'm quite excited. How cool is it that I will get to check a newborn and perform physical exams for the very first time for these little ones? Plus they are cute even if there heads are molded into some interesting shapes from the delivery process. And I am sure I'll learn a ton too. Time to brush up on causes of neonatal jaundice.

Peds soldiers on and I'm loving it. Show me the babies!

this is it

peds is here, i'm 1.5 weeks in and have seen plenty of asthma and RSV... plus a few interesting cases, rare and otherwise. the teaching is great. the hours are okay. the patients are wonderful. so really, no complaints except that i feel like i know nothing. there is so much to read and study but every day i'm learning.

i love the population and the diversity. one minute a 7 day old baby and the next a 17 year old teenager. parents of all varieties. play is part of the job. i heart it all!

In my Alternate Profession...

.... I could wear a costume to work tomorrow.

If I couldn't be a doctor, I'd be be a first grade teacher.

Why? Kids are great, but more than that, I love holidays! I love decorating and I love the festivity of the occasion. It doesn't really matter which holiday, I just like celebrating it. I grew up in a pretty conservative christian family and Halloween was often downplayed. We were allowed to dress up but it was always as benign, non-scary things. (A strawberry, a ballerina, a hobo.) Our candy was frozen for safekeeping (i.e. taken away from us) and everyone knows that once your chocolate is placed in the freezer it is never quite the same again. But I survived and my love for Halloween and all other holidays has only grown with time. Pumpkin carving is one of my favorite traditions and I got to help my niece and nephew with their creations yesterday. So. Much. Fun!




I'd like to dress up tomorrow but I'm not sure the geriatric psych patients would appreciate my efforts and staff might think of me as inappropriate, so I'll settle for watching the Village Parade and counting down to the next holiday and one of my all time favorites- Thanksgiving!

links galore

Just a few recommendations if you are looking for something psychiatric tinted to enlighten/entertain or distract you.

LISTEN
Real 'Sybil' Admits Multiple Personalities were Fake
An NPR Segment that I stumbled upon yesterday...


READ
for the moment/hour/day-
The NY Times Lives Restores Series- Parts 1-3 now available, here is the link to the first article

for the week/month-

"Sybil Exposed" by Debbie Nathan (I'm reading this now, 1/3 the way through and so far I'm intrigued and saddened. I guess the original Sybil work is up next.)

"The Center Cannot Hold" by Elyn R. Saks (I haven't yet read this but it is on my list as well.)

"The Bell Jar" by Sylvia Plath 

This is a classic and if you haven't read it, you should. 

WATCH
In case you would rather a video, this one and the prior two in the Lives Restored Series are well done and get my recommendations as well.

---

That's all for now. Two more weeks of psychiatry. My goal is to prepare for the shelf and stay interested in all of it. Now, back to my book!

how to bribe your patient into compliance?

answer: with coffee and tea. No joke!

Geriatric psychiatry is a lot of things... however holding my interest is not one of them. I tried to give it a fair shake. And for about a week I was intrigued and pleasantly surprised by just how much I liked it. But it must have been the newness, or the fun patients I had that week because my enthusiasm quickly wore off.

 Last week was rough. I didn't really want to go to work and once I was there I just couldn't wait to leave. My patients were belligerent, agitated, hostile and demented. I feel bad for them. But not bad enough to make myself bribe them to take their medications like my Attending does. I mean I guess if getting a cup of tea or buying a cup of coffee is all it takes for a patient to become compliant why not do it? But in my short experience it only works for a limited amount of time. And even if patient complies for the moment/day/week then what? Even if the patient is discharged it is not like we won't see the same patient back next week or month for the same thing.

Medication non-compliance is real. Psychiatry is a revolving door. I wish this were not the case or there was something else I could hang my hat on. But so far that is all I've got.

I only have two weeks left. And it is bearable but not exactly fun. Now the admission notes and discharge summaries just feel like scut work. Write this. Dictate that. Go talk to a patient that is laying in bed naked and refusing to take any medications or put on any clothes or eat any food. Wait for said patient to decompensate to point of needing IM meds or become so dehydrated or hypoglycemic that she qualifies for medical transfer. Type up discharge summary for transfer. Repeat.

Did I mention, I only have two weeks left? But on the upside I do have a whole entire weekend (off) to study in NYC so I'll survive. One latte at a time. Maybe I need to be bribed just like my patients. Oh my...

Adam

Adam was only hours old when I met him. He had been born during the night to a new mother following an uneventful pregnancy. He came into the world in half a days time. The mother delivered her son, without drugs but in a hospital, the norm for Grenadian women. When I met him he was wearing a blue and white sleeper and looked perfect. Tiny, sleeping, a brand new baby. Mother was resting, exhausted but awake and father had just come back with breakfast for both of them.

Adam was one of my first pediatric patients, ever. I was in Grenada at the end of my 2nd year of medical school and it was my second hospital day. After a short introduction from our preceptor on how to interview the mom we were left alone. The mother's story was like any other pregnancy. She gained weight, maybe a bit too much, 40 lbs perhaps, she didn't really know. The delivery was okay, she said it was longer than she expected but no real problems. And then we examined Adam. As we did so our preceptor came back. She asked us to look carefully at his head and eyes and where they were, how far apart there were and if they lined up with his ears. As I slipped off his baby hat I noticed that his ears did look a little low... Then she helped us take off his sleeper and we took off his tiny baby socks.  His feet were curved at some unnatural angle as if they were tomatoes staked to the ground. His hands were clenched but fingers were extended as if they had been glued into position. I listened to his heart and heard a murmur that got higher with each expiration. Another student listened and said Adam was wheezing but I'd heard wheezing before and this was not it.  No, this murmur was a discernable patent ductus arteriosum. My first.

We finished our exam and helped dress Adam. The parents asked our preceptor about his feet and hands and they were told a surgeon would come and talk to them about options. I later asked about genetic testing, it looked like textbook Trisomy 18 but our preceptor just shrugged and said that Grenada lacked such resources, it would take money and time to do genetic testing and so was unlikely...

Adam would be a year old this month. I'm just reflecting on some of my firsts.

Happy Birthday Adam.

the good, the bad and the crazy

 -day 4 and so far inpatient psych is

good - I have a wonderful attending that let's us pretty much do everything. Admission notes, interviews, MMSE, discharge summaries, etc. Some of the other teams are still on "needs supervision" to talk to their patients or write a progress note but we have full reign which I appreciate.
- Our weekly lecture series is going to be great if today is any indication. There is a full time pharmacist that works on the unit and he gave us a great lecture on antidepressants today. Yay for learning pharm!
- I have a favorite pt that likes to compliment me in another language and dances in his wheelchair whenever there is music or mention of the same. You can't be sad when your pt is dancing in his wheelchair.
-Did I mention 9-5, no weekends, no call?

bad - Psych is depressing. Pt's have no insight, poor hygiene, hear voices and scream at you. Treatment is medication (sometimes forcefully) and structure. But a reading room without books and a place that smells like urine half of the time is not exactly my cup of tea.
-I hate the old fashioned keys needed to get into anything on the unit. The entrance is key coded but the rest of the until requires keys. And of course none of the keys fit well so it can take 5 sec or 15 min to open a door. We have computers that are fingerprint access enabled but we need a key to get into the nursing station. Does this make any sense?

crazy-  enough said. Stories will follow.

Pscyh, The Big Apple and Life as I know it-

So, today will mark day three of psychiatry. I'm at an inpatient geriatric psychiatric hospital so my experience is thus limited. However in just the first two days I've gotten to see and do quite a bit and my schedule is strictly 9-5 with no call or weekends so I'm not complaining. And of course I'm in NYC so I'm going to live up these next six weeks.

Museums, broadway, apple picking upstate- check, check, check! Shopping, eating out at super yummy and fancy restaurants, fun runs in Central Park- Yes, yes please and sign me up!

In any case. I'm back in THE City and I'm ready for whatever, whenever and lots of it. And I'm pretty sure psychiatry will keep me entertained during the day at a minimum. Bring it!

Coast to Coast

24 hours ago I was completing my last rounds of inpatient Family Med.

Today I am trying to fit New York City appropriate clothes into a suitcase so that 

tomorrow I can fly across the country in preparation for my psych core that starts Monday.

Life is busy. I will update soon, promise!

"for the dead and the living, we must bear witness." — Elie Wiesel

Today a patient died. I met him in the ER just five short days ago. At that time he was talking, breathing, living. But then he got sick.Very sick. And surgery and medicine and a stay in the ICU could not fix his failing organs or return him to health. His family watched in disbelief as each day he got sicker and sicker... And today they had to say goodbye.

As a doctor in training I am privileged to be with patients all stages of life and sometimes even death. Today is a day to remember and as such I am reflecting on all the patients that I have met whose lives I glimpsed before they were over. I will remember... the smiles, the jokes, the lives of my patients. 

I will remember them because to remember is to bear witness, and this is something I can do.

---

This day in September, ten years ago started normally enough for most people. Preparing for work, boarding a plane, going about their day to day business... no one knew what unimaginable things the day would bring. I was in Boston at college, in class and not privy to the first tower being hit.... but as the news started to make its way around campus and throughout the world my would be husband came to meet me and as class ended I walked out to see him standing in the hall, waiting and in the instant I saw him,  I knew. 

I didn't loose a family member and I only vaguely knew people affected by the attacks, at least at that time.... However we later moved to NYC and then I met countless people who had been there, witnessed the towers falling, walked over a bridge to safety or fled the city afterwards. I know families that decided they could no longer live in NYC and I know people who never-not in a million years- considered leaving. 

New Yorkers have solidarity when it comes to 9/11. So today I partially feel like I'm on the wrong coast. 

People still talk, people still remember, but the events are not quite so raw, not quite so close to home... Of course those that lost their lives on 9/11 were not all New Yorkers. And really it doesn't matter where one is today or where one was ten year ago. What matters is that we remember for those affected by 9/11 and especially for those who lost their lives.

It has been a decade, but we still remember. It is one thing we can do.

To be or remain in a specified place or situation, typically one perceived as tedious or unpleasant

-also defined as the theme of family medicine inpatient (FMI). Well, at least this week.

Patients are "stuck" at the hospital while waiting for placement into a skilled nursing facility or rehab center. They are not longer acutely ill and there is nothing that we are doing for them each day, other than a courtesory exam and progress note. But still they cannot go home and insurance or lack thereof dictates placement, or lack thereof, so they stay in the hospital. Day after day. But what is a good learning experience on day 1 or 2 or even 5 becomes a bit tedious on day 12, 18 or 23. When nothing changes and all labs are normal and meds adjusted. Everyone is bored. Even the nurses pleadingly ask, "when can Mrs. Smith go?"

Patients are "stuck" at the hospital because they need a consult from a service that is MIA or because they need cardiac stress testing but it is the end of the month and the pharmacy is out of persantine or it is the weekend and they must wait until Monday for pathology to give an official reading or for some  non-weekend working dept to sign off.

I am "stuck" in the hospital because my rotation mandates that I am there 12 or 13 hours each day and while these hours make sense for my resident who is covering all the patients and overseeing all the admissions they hardly make sense for me when there are four other medical students on the team and I only get every 5th admission. Especially when we have finished rounding and I have seen all my patients, the same patients that are also stuck at the hospital, and there is absolutely nothing to do while I wait for the hours to pass. So far I've successfully snuck into the OR, slept, hung out in the ER, offered to go to Starbucks for the team, and a dozen other non-FM type things.  I think I may give my patient a manicure tomorrow (because she is stuck, she asked me to, and because that way at least I'll be productive, though knowing my luck there is some hospital regulation again this.)

Yay to being half way done with FMI, almost.

*Oh, and yes I realize I could and should study (and I do) but FM is considered an elective and so there is no shelf exam or test.  Plus the rotation is Pass/Fail and right now Step 2 seems far away....  But if you have any other suggestions for passing time in the hospital, please share!

"Just you wait...."

These words seem to be a running theme lately. If you are newish medical student, or just starting off resident, chances our you know what I'm talking about.

Are these words of warning? Are you trying to save us? What makes other, older, wiser nurses, residents, attendings want to deflate the bright-eyed and bushy-tailed Bambis' of their idealistic views? Why do you need to tell me it won't last? Why shouldn't we be as eager as a toddler to get a new toy?

Three examples:

-My friend Beth is one week from being done with her training and she has a job lined up to work as a PA in the ER. While rotating one day in her future ER, a nurse, and soon to be co-worker tells Beth that she will become like all the others soon enough, JADED. Beth denies this. The nurse insists. She has seen it happen, time and time again. It isn't clear why she is telling Beth this but it makes an impression.

-During my first week of surgery rotations I happened to work a long day. I arrived to the hospital around 4am and happened to talk to one of the nurses about a mutual patient of ours. The RN was working the night shift and remembered me,  so 18 hours later when I was back on the floor checking on a patient before I left for the day she made sure to tell me that my enthusiasm was temporary. She also told me I should go home. And while she was right and maybe I did need to go home I remember in that moment thinking to myself, I hope this lasts, I hope I always care this much about each patient I take care of, this is my job to be devoted.

A classmate started her rotations this week and she is on my FM team. When she got her first patient to admit she did a celebratory dance, complete with clapping and jumping up and down, right in the middle of the ER. I laughed (I can recall my own enthusiasm and the joy one feels when she is finally seeing a patient, by herself.) The resident gave her a funny look as she skipped  happily away. "What is up with her?" the resident asked me. "It is her FIRST patient!" I replied. The resident sighed, "I wish I was still so excited to admit a patient, I don't remember ever being that eager."

And yet, I am sure the resident was. At one time she was an idealistic, eager, enthusiastic doctor in training. Just like we all start out as... Bambis.

And I'm sure those nurses are right. Over time, in a few years, or maybe a decade my friend Beth may become jaded. The ER is a tough place to work. ER staff deals with sick, scared, patients. People can be at their worst and burnout in the ER field is real. But does that mean we have to try and take the idealism away before it wears off?

I did tire of 16 hour days. And note to self-seeing the same nurse separated by two shifts signals it is time to go home. But it will continue to happen. Even if I'm not always happy about it. And I should stay so devoted.

And yes, my classmate will stop dancing every time she gets assigned a new patient to admit. However my hope is that we continue to remember that feeling of enthusiasm from time to time.

Idealist, devoted, enthusiastic. Sure we all still Bambis but you know what, we wouldn't change it for the world, being a Bambi is a pretty cool thing! Go ahead, call me Bambi, I'm proud to be!



(Now where is my nurse like Carla?)

And because we all need some music in our day and not because this has ANYTHING to do with my post...

Revelations!

So, I'm only two day into my Family Med* rotation so I'm not sure if that is really enough time to come to any conclusions. But I'm going to anyhow because I have the time to blog and because in just two days time I've come to realize a few things about myself... First a quick comparison, which is probably not fair to either field but its my blog and I'll compare if I want to!

Going from Surgery to Fam Med feels like running a marathon to strolling in the park. Everything moves a whole. lot. slower. Everyone is nice. The attending bakes you homemade chocolate chip cookies (literally), the resident apologizes for not having time to teach and for being so busy. You are asked repeatedly each day if you need to eat and then given ample time to do so. All patients are seen by the attending, every day! It is like an alternate universe. And I'm not sure what to make of it.

All of this is good. And nice. But it kind of bores me. In two days I've only gotten a single patient to myself. I did help another student with her H&P and co-wrote a single note this morning. Plus I got the priviledge (a.k.a. intern too busy so asks me to do it) of updating our team's entire patient census list which was grand total of 6 patients. But back when I was a surgery student I saw 6 patients/ wrote 6 notes in a single morning.

Okay, so my patient. I did his admission H&P on Monday and today I got to present him to the attending and help her with the A/P so he's mine until discharge.  Except that not tomorrow morning because our team switches to night float for two nights so another team covers our patients (I don't know how that makes any sense but that is how it is). Anyhow, maybe by the end of the week I'll have two whole patients. That's the hope anyhow.

Oh, so my discoveries. Well while we were busy waiting for rounds to start, then later munching down chocolate chip cookies, then later at lunch, then later waiting for rounds to resume and then end, I realized that I did not like that attending had to run off to deliver a baby in the middle of my presentation. Or that the 11am weekly lecture was canceled because of the same. I know, it is medicine and things happen. But I think I need a schedule, a plan. I don't get stressed when plans change per se. I'm okay improvising or adjusting but I do like having structure. And surgery had that going for it. Cases were scheduled. When one finished another started. There was some predictability of what days were clinic versus OR versus just rounds.

Family Med is the embodiment of unpredictability. In the next six weeks I never get more than one day off at a time. My schedule changes every week.  Actually it changes ever day or two. As a medical student on a rotation this is not a big deal. But I cannot imagine a life of this. So I guess that means inpatient Family Med is off my list... which is too bad because the people are SO nice. Maybe it is the laid back nature and the I can deal with anything, at any time mentality that makes these people so cool. So I hope that they can be my friends.  But I guess I'm too uptight for their field.  Surgery vs Medicine: It is the classic do versus think. And come to think of it, I've always imagined myself somewhere in the middle. Child Neurology is a middle ground, right?

*Disclaimer, at my hospital the Family Med rotation is all inpatient so it is really more like an IM elective and probably not wholly reflective of FM


** This post is not to slight either Surgery or Family Med. I met some brilliant surgeons that were quite capable of thinking and even treating the whole patient. I learned a lot of medicine from my attendings during surgery. And it is important that we have people who love Family Med and do it all, it is SO needed.  I just don't think I'm one of them.

Three Months Later

Patients seen: 88
Surgeries scrubbed into: 26
Lives lost: 7
Goodbyes said: 1
Hands held: 15

Surgery is over and I don't think I'll miss the ER/traumas or sad stories that bring the patients to the hospital. I'd rather not have to contemplate skin grafts for the women who fell asleep while smoking causing her bed to catch on fire and burn 30% of her body. Neither cup of noodles nor sparklers should never be given to children to children under 7. Gas stoves or BBQs and unsupervised cooking for children- please no. And just in case you didn't know: grandma driving while on amphetamines,  uncovered empty pools without water, holding a boiling pot of beans in your lap = very bad ideas. I use to think hang-gliding sounded like fun, but after seeing the results of landings that didn't quite work out maybe I'll rethink that. I have had my fill of gun shot wounds and stabbings. Pneumothorax, appendicitis, cholelithiasis - check, check, check!

The OR was actually quite fun most of the time. I can see the appeal, and I even liked about half of the surgeons I met. I'm crossing surgery off my list but am so thankful for the long rotation (even if I wasn't always thrilled during it.) I will probably never see brain surgery or even a lap appy again, but I'm so glad I got to experience them.

(Next time I post I'll be on inpatient family med. Stay tuned.)

Don't know what to call this post- surgery is almost over and I'm still happy to be a medical student

Just four more days of 4am note writing and surgery will be over. One more clinic day, one more call... it is winding down. In some ways I am done with surgery and glad that it is (almost) behind me yet it was pleasantly bearable. I like the hospital and the patients, most of the residents are amazing, my attending is great, I think I've learned a lot. I am now comfortable with all types of wounds, I know how to scrub, suture, tie and I can be of some help in the OR. I like clinic and seeing patients post-op. I don't mind consults and I've survived rounds more often that not.

That isn't to say that I want to go into a surgical field or that I've loved everything about these past 11 weeks but all in all, it could have been much worse. We'll see how the oral and written exams go of course but I'm content.

I have a few favorite patients and a bunch of sad stories to tell including some with happy endings, but that will come later. For now I am just trying to reflect, study and get ready for what is next.

My happy/celebrating patients...

Best news ever?
-How about telling a patient (and her family) that she doesn't have breast cancer. The biopsy was negative and the mass is benign. Yes there was a party in the clinic and yes I laughed and celebrated with the patient. And yes, I got to tell her the good news myself.

2ne best news ever?
-One of my first patient's from neurosurgery, a patient that was at one time in a drug induced coma -went home. I thought he was going to die, but despite the complicated surgery, new-onset seizures and hospital acquired pneumonia he somehow got better. Medicine is amazing!

My crying/scared patients...

Waking up from surgery can be scary. I have never had major surgery but I imagine that waking up in an unfamiliar room with what seems like a million people staring at you musts be a little unsettling. Today my patient woke up and she looked scared. I met her last week in clinic when I did her H&P and I had talked to her before the surgery so she knew that I would be present in the OR. She was having an elective surgery and the complication rate is low. She did well during surgery but it was slightly more difficult that anticipated and so her lengthened surgery status earned her an overnight admission. I held her hand as she woke up and her eyes told me she was scared. I went with her to recovery and told her that we would be keeping her overnight for observation. Or maybe the nurse mentioned this to her, but in any case I had to explain it to her. She didn't want to let go of my hand so I offered to stay. For half an hour I stayed by her bed and answered questions about her surgery. I tried to reassure her and I offered the only thing I could think of my time and my self. Eventually I tracked down the attending to come reassure her and I continued to check on her throughout the day. She will be fine. I was told by a resident that I wasn't acting like a surgeon. But you know- I am okay with that.

Being newly diagnosed with cancer. Being alone in the the hospital over a Holiday weekend. Being in pain. These are depressing things. So understandably my patient was minutes from tears when I entered her room this morning. She felt forgotten about. A simple procedure and biopsy of her mass were put on hold over the long weekend. As she talked and cried I offered her a tissue and she said they were bigger and softer the the hospital issued ones. She most likely has terminal cancer (and she knows this) and yet she thanked me for giving her a kleenex and listening to her. As a medical student I don't have much power, I can't make decisions and my knowledge of actual important medical information is tiny. But I can provide kleenex, hold a hand and lend an ear. Maybe these aren't behaviors of surgeons but they sure make me feel like I'm doing something.

Today was one of the most fulfilling days I've had in surgery. I went to the OR but it wasn't what I did in the OR that I am reflecting upon, it is all of the stuff I did beforehand and afterwards. Patients by their very nature are going to be scared, anxious, neglected. Isn't it our job as physicians to notice this and do our best to help them cry, accept and move on? Isn't it our job to comfort them?

Red, White, Blue and Surgery

Happy 4th of July to all! I am actually enjoying gen sx, suprisingly more than I expected, but that doesn't mean I don't appreciate having a three day weekend and especially today off. I'm home in SD with my hubby and have plans to watch the fireworks later. In the meantime I'm enjoying the day. And I have a bit of time to reflect on what has been two weeks of gen sx so far.

I've seen some interesting cases and have enjoyed clinic, consults and pretty much everything in between. The new interns have arrived and the whole hospital is fresh with new faces and lost looking white coats. I actually feel like I have something to offer the team, my intern finds me helpful and it is kind of refreshing.

I have discovered that I like being in the OR. It is fun, which sounds weird to say and I can't seem myself doing the training or putting up with the surgeon types for 5+ years in order to be in the OR but I do see the appeal.

I have confirmed that I don't enjoy the ER. I don't like the pace, the noise or the rawness of everything. And I hate not knowing what is happening with the patient after they see me. I need follow through and the ER doesn't provide that. However I do like the ER docs. Shift work and cool colleagues are definite pros.

I like clinic. I like taking to and examining patients without too much of a time constraint. I like reading the chart, knowing the history and seeing someone who is going to be followed. I love it when I get to see the same patient for 2nd time, either post hospital d/c or follow-up appt, etc.

So to recap. Surgery- I don't like surgeon mentality but the OR is pretty cool. ER- not my cup of tea, but the ER docs are awesome. Clinic- seeing patients makes me happy.

I hope you have a wonderful, festive and safe 4th!

Tired, but Inspired

My first day of gen surgery went well.  Rounding was done at warp speed and I've decided I really don't like wounds or dressing changes. Not so fun.

Also I was assigned a SOAP note for a pt that had been in the hospital for three months. I spent 1.5 hour reviewing his chart yet somehow managed to miss the part about him having a stroke. But my Junior resident had my back and my senior resident was quite understanding about it. Other than than it was just more of the same. Consults for the ER, yadda, yadda. Yet somehow the day lasted from 4am to 7pm. I was so tired and yet I am still not sleeping through the night. But at least I managed 4 hours of sleep before I was wide awake. I guess I can go in early and give myself plenty of time to read mammoth charts. I don't know what else to do at 3am. Other than read. I recommend this middle of the night on-line browsing and inspiration: In Iran, A Brotherhood of Doctors

Up All Night

So, night float is over. Of course my body doesn't know that. So despite the fact that I start general surgery tomorrow and have to be in to write notes at 4am I am wide awake in the middle of the night. Which would be okay except I've only slept for 3 hours so far. Oh, the transitions. This is the part of the job that you really don't prepare for. But despite what it seems, I am really not complaining. Night float for two weeks certainly beats the alternative of being q4 on-call.  Because on-call really means just working for 30+ hours straight. So the night float system is fine with me. I am now quite comfortable doing consults, responding to traumas, writing post-op notes, etc. I don't know if that means I am ready for the real thing, i.e. 6 weeks of gen sx but I'm about to find out.

And without further ado here is a brief recap of nights: what I saw and what I did, when the rest of the world was sleeping.

10 Trauma Consults- pt in the ER and stable but being consulted for C-spine clearance and/or possible sx.  For example if you crash trying to land your hang glider or a wheel falls off your ATV you'll get a full H&P from the surgery team starting with the medical student. And this does include a DRE. Fun all around, right?!?

2 Trauma Alerts- ER pt that requires a trauma team response (medical student, residents and all ER staff). Perhaps you cut a major artery b/c you were drunk and mad and punched your hand through a glass window- this is where you'll end up.

5 Trauma Activations- ER pt is being transferred or walks in off the street in possible critical condition so entire trauma team + Attending responds. (Medical student does the paperwork.) Stab wounds, gunshot wounds and high speed MVAs all end up here.

ER Consults for Surgery/Admission- Abdominal pain that might be surgical. Post-op pts with irretractable pain or a fever. People that do stupid things requiring surgery for removal. These are the bread and butter consults. My most common consult was for gallstones +/- pancreatitis.

OR cases-
3 lap appys (2 x I got to drive the camera)
2 toe amputations
1 perineal abscess I &D
1 open exploration for small bowel obstruction
- suturing is harder than it looks!
- first knots tied = fun (thanks Dr. BF for all the tutorials)
- first opening incision

Not to mention countless hours of TV watched in the resident lounge and a few hours of sleep stolen while waiting for something to happen. All in all nights were an okay way to get my feet wet, now it is time to swim.

Good night!

Transitions and such

Tonight starts the first of my night float section of surgery.  I am not really ready to be done with neurosurgery and I guess the team feels the same about me as I was invited to scrub and assist in a case tomorrow. I hope I am awake enough after being up all night. Can you say coffee? With any luck I'll see a trauma or two and perfect my consults and post-op notes tonight. And then see a cool neurosx case in the AM. Have I mentioned lately how much I love med school and third year?

And, in other news I finally found out my placements for the rest of the year. My schedule looks something like this!

Family Medicine (6 weeks) -CA
Psychiatry core (6 weeks) -NY
Pediatrics core (6 weeks)  -NY
Holiday break 12/19 - 12/30/11
Ob/Gyn core (6 weeks) -NY
Medicine core (12 weeks) -CA

So all in all I am very happy with this. I get to stay at my current hospital for FM and then only move across the USA once. Hopefully I can set up sub-Is and electives on this coast for 4th year.

I am one step closer. Time to work. Have a wonderful night, I'm off to the hospital.

It IS brain surgery

So far I'm s/p day two of week two in my neurosurgery rotation and I have:
performed my first lumbar puncture
observed a craniectomy and tumor resection
watched a patient go into surgery talking and emerge aphasic
witnessed seizures and gotten crash courses in how to read an EEG and prescribe AEDs
assisted in a subdural hematoma resection x 2
seen a stroke patient in his final hours
held hands with patients pre and post-op
seen all varieties of aneurysms: s/p rupture, coil and clip
worked with three amazing residents that take the time to teach
scrubbed for surgery four times
been told I need to read and I should know this or that
been told I am the best medical student in a long time and that I should consider applying to neurosx

It is fascinating, it is exciting. It makes being at the hospital from 5:30am until 6pm or 7pm or 9pm seem like a blink of the eye. Clinical rotations make the first two years worth it. I know that I am only starting my third year and that I don't really know that much, but I know that I like clinic and I like patients and I like talking to their family members. I like being at the hospital. I don't always know what to do but at the same time, I feel like I belong. And so- being an MS III is a good thing. (And now it is time for bed.) I'll have lots more to share once I am done with my rotation (only three more days, -tear-sigh) and have had time to properly reflect...
Stay tuned.

Lost (and Found?)

Since I'm on the "study hall" portion of my surgery core I have a bit of time to roam the hospital and ponder life. And I am studying. I've read/outlined the first 19 chapters of Lawrence's "Essentials of General Surgery" but it doesn't take an entire day to read three chapters so I have some time.

Last week I went to the ladies room and found a very well-loved lost lion in my stall.

I found him propped up, just like this so I have to think that he fell out of a stroller or was dropped and someone hung him here in hopes he would be reclaimed. I checked the restroom later in the day and he was gone so hopefully his owner was happily reunited.

I don't have any patient stories or amazing tidbits of info to share with you (yet) but I'm one week closer to being on a team, writing notes, rounding on patients and all of that fun stuff. In the meantime I'll leave you with this fun fact: the liver has over 2000 metabolic functions. So love your liver, because it loves you! Oh, and good luck to any and all of those "already brave" lost lions (and other well-loved stuffed animals) out there.

-Kudos if you read a rather amazing blog and get the reference!

False Start

So,  I have been orientated. I am at my surgical site and new home for the next three months. But due to new SGU guidelines our 12 weeks of surgery now includes protected study time. Which is great, but guess what? I ended up getting my two weeks of study time upfront and my six weeks of general surgery at the very end until the day before exams. Yippee for me! (NOT.)

So no early morning rounding for me or scrubbing in to watch a case, or any of that. Just sitting in the assigned library or conference room from 8am-4pm. Of course I can take breaks and leave for lunch but it kind of feels just like studying for Step 1. Sure I get to walk around the hospital in my short white coat and attend all the resident and academic lectures but I just don't feel like a third year. I know, my time will come. Pretty soon I'll be wishing I was back in the library with the entire day to read (at least this is what I am telling myself.) I have entertained the idea of just walking into a patient's room and assuming her care like I belong there, no one will call if there are extra notes in her chart, right?  Fine, I suppose I will just stick to pre-reading for surgery. It has been a long day. In a quiet/boring kind of way.

Time for Fun Facts:
-A normal healthy person sighs 9-10 x per hour. This protects the lungs from atelectasis. (Patients undergoing and awakening from anasthesia do not sigh or cough and thus this is a possible complication. I'd never thought of sighing as protective, had you?)

-Licorice consumption can lead to renal potassium loss. (Okay, I think I knew this one, but it is still pretty cool, so be careful what you eat!)

There are more, but I don't want to bore you. I am 90 pages in to Lawrence's "Essentials of General Surgery" and I have to say, I wouldn't be if it were not for this protected study time, so yay!?!

13 days until my neurosurgery rotation, at least I have that to look forward to!

(gulp)

Tomorrow is my first day of third year. I think I am ready but it seems like I can't really be ready because I have no idea what this will be. It feels like the first day of school and the start of first year all over again.

For those of you playing along at home I got my first choice in that I got to stay in California (for now). I was assigned surgery as my first rotation which is 12 weeks long.  And while I am not at a clinical center I am within driving distance of Dr. Boyfriend for weekends, etc. Of course after surgery I will have to most likely move and then move again and again but I don't know what comes next so I really can't worry about it right now. Instead I just have to focus on remembering my anatomy and being the best third year I can be.

The new apartment is set up and unpacked. My fridge and freezer are stocked. I have clean laundry. I guess I'm ready. In the meantime I am enjoying a glass of chilled wine. Cheers to surgery!

Confessions of a Med Student- Part V

After much delay this is the final Grenada installment of my confessions series. The following post is all about Term 5.  Follow these links for previous terms: 1st -  2nd -  3rd -  4th

The schedule: Pathophys, BSCE (Basic Science Comprehensive Exam Review), Pharm, Clinical Skills, oh and don't forget to self study for Step 1!

Lectures are in the afternoon which I liked much less than morning lectures. Because I went to class most of the time I felt like I never really had a chance to study until after dinner which is a bit late to start (think back to first term, yikes!) and what this meant for me was that I had a lot to cover on the weekends and that I rarely went out during the week. I found that 5th term was just a busy as 4th but that might have only been my class going perception.

Mornings are consumed with small groups and clinical rotations. One day of the week you go to the Hospital for Clinical Skills and mini-rotate through the different wards. In theory you get to see a variety of patients and practices but really the point of this is not to learn about pediatrics vs OB/GYN vs Family Med (that's what 3rd year is for!) but to practice taking histories and doing physical exams. As long as you don't expect that you will be suturing in surgery or actually doing anything of importance this can be a fun morning to hone your skills and meet a variety of Grenadian docs. I enjoyed being about to see the difference between the hospital, private practice and clinics. It was educational on many levels. Grenada does not have the resources of a well developed country and so the type of medicine practiced did not always reflect the US style health-care system but there are fundamental similarities and for the most part the teaching was good and the patients more than willing to assist as themselves.

There is a small group for everything! Pharm, Clinical Skills and Pathophys all include a morning session and depending upon the tutor/Prof/subject they ranged from helpful group learning experiences to a total waste of time. In theory these were great but in reality it was lots of busy work preparing for the sessions and then attending, etc. And because these were in the morning I tended to not get a lot done beforehand or during the lunch break. I think it is because of the schedule that so many students stop going to class. Small groups + mid-day break/lunch + class = day over and no studying accomplished. If I could have stomached sonicing I would have but alas I had to stick out the lecture hall. Hence my lack of life outside of 5th term. But I guess it is medical school after all...

Class in and of itself was okay. The pharm department is well run (I heart Dr. Dasso) and lectures are as exciting as pharm can be I would guess. Basically it was biochem on drugs. I hated biochem and found pharm to be a fair amount of work and a ton to memorize but I somehow survived. Small groups were a bit tedious for my liking but overall I think SGU pharm prepares you well for Step 1.

Pathophys is taught in conjunction with BSCE and is basically a huge review course: Pathophys is a subtle repeat of Path minus the morphology and BSCE is a review of everything else (anat, biochem, histo, physio, etc). I annotated into First Aid and started doing questions in prep for Step 1 as part of the class studying because at this point it all becomes one and the same. Which is not to say that prepping for BSCE or spending Friday afternoons in Taylor are enjoyable but if you use your time wisely the work you put into BSCE can be helpful come Step 1.

I already wrote about Clinical Skills. And actually I thought these small groups were some of the best. Each week a different system is assigned and the tutor takes you through a case and review which as a group you use to review the system and arrive a diagnosis. (Bonus- minimal prep needed besides reading through that section of First Aid and the class notes.)

All in all, 5th term is like your senior year of anything else. It is physically hard to be in Grenada and you just want to go Study for Step 1 and be done with basic sciences already. But the classes are okay and the material matters so you just do it. And then before know now it, you are packing your suitcases and shipping your things home. Grenada is over and two years of your life never felt so difficult, rewarding, simultaneously long and fly-by quick. Then you take a break (optional) and prepare for an exam that will test your past two years and determine your future. So yeah, that is 5th term in a nutshell. I hope this has shed some light on the final term of basic sciences. I do not yet miss lecture, but I do sometimes miss Grenada. Enjoy it while you can.

Time's Up!

So the torture is over. I have officially been notified that I will start rotations in California at my first choice spot. I still won't get to live in the same city as Dr. Boyfriend but we'll settle for the same state and time zone.

I can't believe it. In just two weeks from today I will be starting my third year rotations with surgery. Which means I need to do some serious anatomy brushing up before then. And find an apartment. Buy a car. Pack and move. Little things really...

tick tock

I'm back in NY and staying at my mother-in-laws. Last night I could not sleep. Maybe it was the jetlag or sofa bed mattress but as I tried to count sheep I could only hear the tick tock of the wall clocks. I ended up taking them down and stuffing them into a closet but even the perfect silence couldn't lull me to sleep.

A few of my classmates have received their clinical placements but I am still waiting. I have few bad things to say about SGU (I am more than thankful for the opportunity and I do believe the school does a decent job educating us) but I guess the sheer number of students overwhelms the Clin Ed office plus when it come to communicating with us and administrative issue SGU leaves a bit to be desired. But it is what it is, I'm just going to whine about it.

So, in the middle of the night when I couldn't sleep I started composing a few blog entries in my head. Why is it that it seems so easy to be eloquent at 2am in the morning. In the light of day the ideas are like dreams, the concept is remembered but the grandeur is missing.

Anyhow. I never finished my Confessions series and I need to do that before I completely forgot what it was like to be in Grenada and all that was 5th term. And I do want to post on my Step 1 strategy for those of you wondering. I promise I am working on them. Maybe I'll get around to posting both before I find out where and when I start third year. That seems reasonable/likely.

The Waiting Game

Disclaimer: Whiny post ahead. Since I have nothing of substance to blog about I'm whining. Feel free to skip this one and come back another time.

Waiting is so hard. The agony. I really thought that once I had my passing Step 1 score I would be assigned a clinical site. Previous correspondence from Clin Ed had been received to confirm that I could start in early May in California, which I would LOVE to do and I replied accordingly. Yet May is now less than a month away and it would be nice to know WHERE I am going so I can find an apt, buy a car, etc. Little things I know. Yet despite many emails and inquiries Clin Ed will only tell me that they have not yet begun placing students in California. No timeline, no promises. They are masters of being vague.

Me: "Is Arrowhead  (a hospital in Colton, CA) an option?"

Clin Ed: "We will note your preference to be placed in Arrowhead and if it is an option you will be considered for a spot there."

Great, thanks! For nothing. (Sigh.) Previous terms have been given a prelim placement spots but I guess it was problematic so they changed they system this year and we are not given a chance to appeal our placements.  We were able to request an area, at least in theory. They assign us, we go. I can live with that but I did think I'd know by now. On the bright side I leave for NYC in just three days. One final vacation before third year starts, whenever that may be...

what is 46xy?

My 4 year old nephew asked me this just the other day, "what makes a baby a boy or a girl?" What a good question nephew. Well I'll save you the answer I gave him but offer a link instead.

Enter Grand Rounds last week's edition that I just got around to reading now... Zoe (I've always loved that name) is a rocket scientist from Australia that just happens to have a chromosomal abnormality. Her blog and story are both fascinating and enlightening. I spent the morning reading her blog and thinking about this. I invite you to do the same, this is the entry that got me started, They mean well (Part 1). Happy reading!

I have always been interested in ethics, maybe pediatric endocrinology isn't out of the question.

Pass

I haven't been able to sleep since I took Step 1.  I'm not normally prone to insomnia but the anticipation of my Step 1 results has made sleep these past three weeks a difficult feat. My niece woke me at 5:30am this morning and although she crawled in bed with me and immediately fell back to sleep I was wide awake. I knew that today would bring my results.

I'm not sure how I feel about my score but I know that I will be a doctor one day and this is another hoop I've successfully cleared.

I will write more later about what I think worked and did not work for me. For now, I'm just going to await my clinical placement and start planning 3rd year.  I guess I'm trading one anticipation for another. I've been doing a bit of networking and I may try to shadow a pediatric neurologist in my area. It would be nice to have options for 4th year. Time to move on. (After I enjoy the rest of my vacation that is.)  Happy Wednesday!

auntie love

I love being an aunt. I love the feel of little hands searching for mine in the dark theatre and not letting go, the entire show. I love the questions, the awe of a 7 year old and the smarts of a 9 year old. We had a most wonderful afternoon, just us three girls. No tears, no fighting, just a fun-filled time watching Cinderella (the girls favorite), Little Red Riding Hood (my favorite) and a few other story book characters come to life in "Into the Woods" the musical.  We only stayed for Act 1 and it was perfect in length and substance. Not too long, not too scary and everyone got their happily ever after...

I love being an aunt. I love that we had to dig up bugs with big sticks. I love that during hide & seek the same hiding spot never gets old. I love that at 4 years old he wants to know when his voice will change and that I am the one he thinks to ask. Boys can be fun too.

I love being an aunt and for the next 8 days that is my sole purpose. 
(I promise to return to normal med school blogging soon.)

one too many

So I am home (where I grew up, where my parents reside and where my sister and her three children live) for vacation.

I love being auntie to my two nieces- 9, 7 and 4 year old nephew. However three is just one too many. I can't possibly hold all three of their hands when crossing the street. I can only sit by two of them at the dinner table and no matter how hard I try someone is always left out. I just try to be mindful that it not always the same one. I try... but my iphone is often the surrogate me. Luckily my iphone is a big hit so the left out one is usually pretty happy.

I like to believe that children should not outnumber the adults. Of course I am breaking my own rule and taking the two girls to see a musical tomorrow afternoon. I hope I survive.  Right now I'm off to bed because my 7 year old niece likes to get up before the sun (yawn).

Correspondence

To: Spice Island Queen/Student
From: Clin Ed/SGU_LN
Sent by: ABC/USL/SGU_LN
Date: 03/25/2011 12:29PM
Subject: USMLE Step I Results

Hi Spice Island Queen!

At this time we still have not received the results for the Step I exam.  Please email a PDF copy to clined@sgu.edu  as soon as possible.

Regards,
ABC
Clinical Placement Coordinator

Dear Clin Ed,

I don't have my Step 1 results either! I am expecting them any day and will forward a copy to you just as soon as I receive them.

Fingers crossed,
Spice Island Queen

P.S. A friend who took the step 4 days before I did said he received his score report exactly 3 weeks after his exam so if that schedule holds I should receive my report on Tuesday the 26th.
 

7 words

Describe the thing you love most in seven words:

boyfriend is the perfect one for me

(my) rainbow in an otherwise dark cloudy sky

acts like life's purpose is my happiness

excellent doctor, like I'll strive to be

---
I don't often blog about my husband but he is my best friend, cheerleader, support, entertainment and the love of my life. I couldn't imagine medical school without him by my side (via Skype counts).

It has been a decade of togetherness and although neither of us are perfect I do believe we are perfect for one another. This is my blog about medical school and becoming a doctor but my relationships are part of that process and his is one of the most important in my life.

To love and life happily ever after!

The Blog Challenge

Since I'm in third term limbo I have just a little bit of spare time on my hands. Today's entire agenda was getting a massage. Yep, that is it. Don't feel too sorry for me! And tomorrow.... I have absolutely nothing planned or anything that I must do. It is great but at the same time kind of boring, but I can always read another book. I talked to my mom today and she remarked how it would be nice if I could somehow bottle up the spare time and save it for some future use. Agreed. Anyhow, I've been spending my oodles of spare time reading and stumbled across a new blog and this idea. Post something every day- for a month. But I don't want to just write non-sense so I'm doing this- NaBloPoMo. Let me know what you think. If you also blog I challenge you do do the same.

Today's prompt:  Give us links to five must-read web sites you go to every day and tell us why.


Somewhere during 1st year I discovered Google blog reader, it saves tons of time and all my blogs are in one spot. I only have to check my home page to discover new posts. Here are my current favorite 5.

1) Grady Doctor heartwarming, thoughtful, poignant posts about life as a mother and physician in a teaching hospital. Often her posts make me laugh, smile and even cry.  She is truly inspirational.

2) Mothers In Medicine  I have been following this blog since the start of medical school. I hope to one day be a mother and this blog gives me hope.
 3) A three way tie for third-
A Thousand Times Over 
Tales of a Brown-Haired Freak 
A Caribbean MD is Good Enough for Me 
All three are written by fellow SGU upperclasswomen. They keep me grounded, anticipating what comes next and looking forward to the next step.

4) Getting Better- a hybrid of diverse medical bloggers all in one spot, what is not to love?

5) A Farmer in the Dell  A blog about food and farming. There is something appealing about contemplating dinner and dessert. Maybe I'll be a farmer in my next life.

So those were my daily blogs. But of course I don't read JUST blogs. The other website that I visit every day is The NY Times because every girl needs a news source. I like that I don't have to read about celebrity meltdowns on NYT and for the most part it keeps me up to date in current affairs. I don't like that I will very soon have to start paying to read this. So sad...

Well, that is all for today and this post. Until tomorrow!

Confessions of a Med Student Part IV

This is a little late in coming but welcome to the fourth installment of Confessions- my reflections of past terms, one at a time. If you want to read any of the prior confessions series you can find them here, here and here.
----

Term 4: the breakdown-
PATHOLOGY with my Path Group NOS 
the dreaded MICROBIOLOGY
plus to keep you on your toes- CLINICAL SKILLS

So this the term you have been waiting for. You have only heard scary rumors and sad stories of students that had to decel. And now it is here and you have already been on the island for six weeks completing third term and you just want to start already. You may have pre-read some of Robbins and every single upper classman has told you some conflicting thing about this term but you don't really know what to think. Do you go to class?  Do you use Goljan's Rapid Review or just rely on Robbins.  Baby Robbins and Big Robbins? Annotate into First Aid? To be or not to be?

Anyhow, for me I was apprehensive but prepared. The best part of fourth term is being able to pick your lab group. And I think this can make all the difference. I had my lab group solidified before 2nd term was over and having a group of classmates that I knew and trusted made lab fun instead of torturous. We were Path Group #1 aka Path Group NOS (yes, we named our group and we even wore matching scrub tops to lab occasionally... there is this whole must be dressed professionally thing that we were trying to do without actually dressing up or wearing white coats.)

Anyhow, my lab group started with two friends* that I had studied well with during first and second terms. We each then asked other study partners or lab partners from previous terms and in the end we had a pretty diverse group of students. Some young, some older. Some AOA, some not. Some girls, some boys. Some Russians, some Indians. Some from Canada and some from the USA. We met for pizza at Prickly before 4th term started in order for everyone to get to know everyone else. And we continued to hang out at Prickly during the term, once after the first exam and another time towards the end of the term for Dundy (think "The Office" TV show) style awards. We had fun and by enjoying lab and each other we kept sane and made it through.

*Note, I had other friends who were NOT in my lab group and this became important for several reasons. 1- If I ever needed to gripe about my lab group, which wasn't often but on the rare occasion when I did, I could to so with friends not in my group. 2- I studied with someone who was in another lab group so we could share what our tutors had highlighted, trade slides, etc.  My opinion is that it is okay not to have your roommate, best friend or primary study partner in your lab group, and in some ways maybe even better. 

So Pathophysiology... Lots of time spent in lab, but that can be okay, IF you have a good group. Or it can be time to sit and read Goljan or Robbins, it is really up to you. Same thing applies to concept maps. Most students hate them and think they are a waste of time. And I can see how that might be the case, but if you choose to make a concept map on something you need to learn, or have trouble remembering it can be helpful. I used my concept maps during pathophys and even studying for Step 1. But you can also scribble something out in 5 minutes and hand it in too, again it is up to you.

Besides lab, I did go to class but then I was always a "go to class" kind of gal. It really depended upon who was lecturing but most of the time I felt like I had to be there. If you sonic you miss the slides and since it is path slides are helpful.  Sure, not all the VPs were amazing but for the most part I like to think that going to class only helped me. 

Path was difficult, not because it is hard, but just because of the enormousity of it all. But it is doable and I found it fun. You are learning the stuff you came to medical school to learn, or at least that is how I felt. I didn't read Robbins cover to cover but I used it to prepare my slides and look up stuff that wasn't well covered in the notes. I tried to review all the green boxes and know the images. I also had Baby Robbins which lived in my bag through 4th and 5th term (plus it is pocket sized so I can use is during my clinical years too.) I didn't use Goljan or First Aid until 5th term but sometimes they would have been helpful. Best free resource, webpath! I made myself do the questions on Friday nights when I was too burnt out to study anymore. Also I did Robbins review questions with a study partner and found it kept me from falling behind. We had a standing date each weekend to do questions from the previous system. For me, staying caught up on the material was key. And by going to class and having regimented study dates I never really had a chance to fall behind. And speaking of falling behind, that brings us to micro.

Microbiology. I only think this class gets a bad rap because it is taught in the same term as Path. The key to this class is to not fall behind or let path overshadow it. Again I went to class (85% of the time) and being in class made me strive to keep up with the material. I would spend a full day every other weekend organizing my notes, making tables, etc. For practice questions I used High Yield the days right before the test. It wasn't the easiest of classes, but it was fairly straightforward IF you put in the time. (And SO important for later, aka pharm and Step 1.)

Clinical Skills. This was the class I expected I would love. But it turned into a pain and time suck which I blame on the lack of organization that is the Clinical Skills Dept. They have so many smart, capable physicians, but yet no leadership or organization. The class does teach you needed skills, how to interview a patient, do a physical exam, etc. it just isn't very efficient. As far as exams I found that doing practice questions from old exams was helpful. And pocket Bates is useful without being overkill. Also for the practical exams it did help to have a couple of friend and actually practice all of the skills with beforehand. (It amazes me how so many of my classmates just tried to memorize their way through.)

So that is fourth term in a nutshell. I think it really was my favorite term (but that doesn't mean it was easy or that everyone I knew made it through.) But with some preparation, a lot of hard work, a good lab group and a dash of good luck you will survive it too.

I promise to post on 5th term before another month goes by. Stay tuned.

Happy Match Day!

So, today is the day that all fourth year medical students await. Today decides their fate. You see on match day one is "matched" with a residency program and it isn't until match day that the medical student finds out where she will be completing her residency. Of course the medical student knows that she will be matched to one of the programs on her rank list (and if she didn't, she would know this and have scrambled, more on that in minute.) She has interviewed and carefully constructed her list, but it may be 20 programs long and involve five different cities and states so it is with trepidation, excitement and anticipation that match day arrives.

I was with Dr. Boyfriend on his match day. Most US medical schools, his included, hold a special ceremony where everyone is given an envelope and at noon they open the said envelope and smile, scream or cry with relief or disappointment. I was with Dr. Boyfriend and his classmates and most of them matched to one of their top programs (like #1 or #2 or maybe #3 or #4, rarely further down the list. Plus 96% of US medical students match so the scramble is the exception.) Anyhow, I was with him and he matched at his top choice in OB/GYN and it happened to be where I was living/working so we were both happy, relieved and excited. Most of his classmates were also happy. I remember one girl who matched to her #1 choice (but for some reason in her mind she thought she was going to match further down the list to a NYC program.) Anyhow, there she was crying and upset and we all wondered what to say, "I'm sorry you matched to your #1 program????"  Well fast forward a few years and she is married and very happy at said program but the thing is, you never know, and the match is out of your control is so many ways.  It shapes the next three-five plus years of your life and this decision comes via a computer.

So back to that day of Dr. Boyfriend's match. His graduating class was around 100 students so there were just a couple that had to scramble. I know that they all did scramble and I forget details but I think someone matched for categorical but needed a pre-lim year and hadn't matched, so he scrambled and ended up in Hawaii. We all laughed and thought, well that isn't too bad, I mean it is Hawaii for a year! So yeah, that has been my personal experience with Match Day.

So now six years later I am in the middle of medical school, but it is not a US school and so Match Day for my types goes a little differently. I still have two more years until I will be the one matching but I pay attention to my upperclassmen and where they match, how many match, etc. It is still early in the day so SGU has not yet updated the list but here is the link. Right now it only contains those that pre-matched (aka signed outside of the match, this is one of the only advantages to being a IMG), matched to a Canadian program (their match was last week) or matched into a program that uses an early match system (mainly competitive programs like ENT, Plastics, Ophthamology so that students that don't match can try to again with the regular match in a different field.) Anyhow the list is just a fraction of what it will be. So keep checking if you are interested.

So far I haven't heard too much about students scrambling, but then again I'm two years out and don't really know that many upperclassmen. I guess only time will tell. In a given year we are told that 85% of SGU student match. Now that includes everyone and being an international medical school not everyone tries to match. And we know that some sign outside of the match. But there are of course an unlucky few... So, fingers crossed for all of those matching today, that they did in fact match or were able to scramble.

So, about the scramble. On Monday those students that did not match were notified. And on Tuesday a list of program that had not filled was released. Last year there were 8,794 unmatched applicants and only 1,060 unfilled spots. So if you are one of the unlucky few and not taking in account anything else, you have a 1:8 chance of scrambling for one of the coveted unfilled spots. And it is a scramble, the student and any help she can recruit calls, phones, faxes, emails and begs for an interview in hopes of gaining a spot. This is another time when being a US medical student has its advantages. If you need to scramble and chances are, you don't,  most likely your Dean will make some calls on your behalf. If you go to SGU, well good luck with that. Needless to say, you don't want to scramble.

I cannot even fathom what it would be like to finish four years of medical school and then not have a place to go for residency. This is the real underbelly of being an IMG, what they don't tell you at the open house and what you hope is only a rumor or thing that happens to those less fortunate students that go to lesser schools than the Harvard of the Caribbean. Now it is looking a little bit better for next year. The NRMP is introducing SOAP which from what I gather will be a controlled scramble, basically a 2nd match. To read about these changes see the NRMP website and SOAP pdf. I don't know if it will help IMGs like myself but I guess time will tell. I think it will help the highest qualified applicants secure a spot and will take much of the "luck" out of it. Sure the US students will be served first, but that is how it is now anyhow.

So to all those matching today, I hope that Match Day gives you much to celebrate. Go enjoy a green beer and cheers, you've worked hard for today!

What WIll I Be?

What kind of doctor will I be when I grow up??? Match Day is tomorrow and as my fellow classmates find out where there will be training I can't help but wonder what I will be matching into in just two short years from now.

SGU's office of career guidance website hosts a Pathway Evaluator, so I took a few minutes and filled out the questions and came up with this list of my top 10:

Internal Medicine
Geriatric Medicine
Child Neurology
Endocrinology, Diabetes and Metabolism
Neurology
Child and Adolescent Psychiatry
Pediatrics
Psychiatry
Rheumatology
Medical Oncology

The thing is, if you asked me today, what I wanted to do I would tell you pediatric neurology (and it shows up on the list above as #3, for what it is worth...) And I do think I could do that and be happy. But there is so much to medicine that I have never experienced and who is to say there isn't something else I would like better or be better suited to.

I know (or at least I think at this moment) that I want to work with children. Soon I will start clinicals and I'll get my six weeks of pediatrics to confirm my intent. But I have to wait until fourth year to do a sub-I so if I am interested in pediatric oncology or child-neuro or genetics it will be at least a year before I am experiencing them first hand, so that means that for the moment I'm stuck waiting. I've been thinking of trying to find an SGU alumni in the area to shadow. What it really comes down to is that I'm getting impatient. I want to be on the floors yesterday. And I really just want my Step 1 score to arrive in the mail so I can stop thinking about it.

A Day at the Museum

It was resident free Tuesday so I went for the afternoon to the Museum of Man. My favorite moments had to be:

1) when viewing a skull with lytic lesions due to syphilis a couple walked by and the girl said, "honey look, this is what happens to your brain when you get infected!" True, syphilis is bad and not just for your man parts. Maybe this is a good way to keep STDs at bay.

2) watching the very pregnant woman and her husband (no children were with them so I assume primigravida) in front of  the Being Born exhibit. I mean it was pretty good exhibit showing the baby in different labor stags coming down the birth canal but it just seemed ironic that there she was, about to pop and she was studying how a baby is born.

Clearly, life after step 1 is pretty good. I also finished my third book in a week while I sat in the park... I love people watching.

Boyfriend's Carrot Muffins

Since I have time to bake again and husband was craving some carrot muffins I came up with these. They were inspired by this NYTimes recipe but I didn't like the recipe contained oil so I made my own, aka adapted from several others. (Dr. Boyfriend is doing Weight Watchers and I try to make baked goods that he can eat and not have to sacrifice many points for....)

To make this is what you need:

• 1 1/2 cups all-purpose flour (or soft white-wheat flour)
• 3/4 cup brown sugar (or 1/4 cup Splenda brown sugar blend)
• 2 teaspoons baking powder
• 1 teaspoon baking soda
• 1/4 teaspoon salt
• 2 teaspoons cinnamon
• 1/2 teaspoon nutmeg
• 2/3 cup nonfat vanilla yogurt
• 2/3 cup skim milk
• 1 1/2 cups grated carrots
• 1/2 cup chopped walnuts (or raisins or both!)

Preheat oven to 400 degrees. Mix all dry ingredients and slowly stir in yogurt and milk until wet. Fold in nuts/raisins and divide evenly into greased muffin pan. Makes 12 medium sized muffins. Bake for 20-25 minutes, toothpick should come out clean. Enjoy!

Muffins as made with wheat flour and Splenda blend (no raisins) are 2 points per muffin for Weight Watchers Points Plus.

Life After Step 1

Step 1 is over!!!! 

Yep, I sat for it last Tuesday and life after Step 1 has been good. SO good that I just haven't sat down to blog or reflect. I've been too busy trying to cook/bake/read/walk/explore/spend time with Dr. Boyfriend/make travel plans/etc.  

I won't know until my score arrives if my study method worked but for all of those wondering about how I studied I'll try to put together an overview and post it at a later date (once scores are in hand).  In short I used all the normal stuff, First Aid, UWorld Q-bank and personalized schedule with some help via CramMasters iPhone App.

Right now, it is time to enjoy my vacation. I'll be back later. Match Day is Thursday, good luck to all of those matching!

Tetanus Induced Fake Smile

... due to facial spasms, aka Risus Sardonicus. I am just two weeks away from Step 1 and on my third pass through First Aid. Every once in awhile I notice or learn something new, not sure that you will find it as interesting as I did but I just wanted to say I'm still here. I promise to finish my Grenada reflections once the exam is over so until then, or until the next random fun fact. Back to USMLE World I go...

Different view, same thing

-my view while studying from a hotel in San Francisco. I'm here with Dr. Boyfriend while he is at a conference. A change of locale is as exciting as my studying gets but at least my lunch break involves a new city block to explore and I am taking this weekend off to enjoy Napa so I have that to look forward to. (Plus wine is always a good thing.) One month to go. Sigh.

Lap puppy in a coffee shop

I finally found my coffee shop, a home away from home to study at. Big tables, comfy purple chairs and random puppies. I'm not exactly a dog person but this one's owner asked me to hold her for a minute while she washed her hands. Then she put her in my lab before I could object and she was cute...

 

Anyhow studying is on schedule and going as planned. My test is scheduled for March 8th, so now it is just about memorizing First Aid and doing World questions every day... when I'm not too busy puppy sitting...

A Walk in the Park- Bunnies on Leashes and Lazy Lion

Week three, day two of studying. Nothing really to report. I plan to take a practice exam at the end of the month and see how much progress I've made. Until then it is just review, questions, First Aid, repeat.

Because I've been studying at home more than not my breaks have been walking to the park. And well the most exciting part of my day is usually found on these walks. I don't know why but a guy had three bunnies on leashes but it made my want to take a picture.

Also last week we had friends in town so I took a study break and went to the Wild Animal Park with them. Lazy lion napping on random car in his exhibit.

Now it is time to get back to chicken-wire and fried eggs. (Hats off to you if you can name the pathology to which I am referring.)

Beware of Polar Bear Liver

Did you know that eating polar bear liver may cause Vitamin A toxicity? Just a random fact learned today.

It is day three of Step 1 studying and besides my four new packages of gum I don't have anything more exciting to blog about right now (but btw, I totally recommend the Stride flavor- Mega Mystery.)

Back to it, enjoy your Wednesday!