Thursday, September 29, 2011

Peds: Day 12

Another day of inpatient is through...pretty much like every other day. I had a patient with a groin abscess, an infant with increased frequency of seizures, and my infantile spasm kiddo. 2 of them were discharged home today, so I was busy with paperwork for a portion of the afternoon. There's only 1 day left and it is with a heavy and disappointed heart that I admit that I have not actually learned anything from my teachers. I can't tell you how sad this makes me. When I am an attending (and even while I am a resident), I will not treat my students as poorly as I have been treated. If you know me, you know how eager I am to learn, how happy it makes me to see patients and to learn from them. But I just haven't been given any guidance throughout this rotation, and I am afraid that my education has suffered. I only have 2 weeks left of peds, and I may never have patients like this again, and I have missed out on so many good learning opportunities. SO, in an attempt to correct this deficiency, I have decided that: I will take even more initiative in approaching my residents and attendings so that I may ask them questions or review my cases or topics with them; I will take the time to teach my students at least one topic that we encounter during rounds each day; I will pimp my students; and I will encourage them to challenge themselves with things they are uncomfortable with doing.

Oh I should probably explain what "pimp" means...its when an attending asks a student questions regarding his patient or just questions about anything, really. And when you get asked these questions, you are put on the spot, and you are singled out of the group and need to answer in front of your peers. So if you get it wrong you feel like a real idiot, and if you get it right but show that you aren't confident you appear incompetent in front of your peers. It's so uncomfortable to me, to be asked questions and have to answer while in front of a bunch of people, but I learn things so much better this way. If I get it wrong, I never forget it; if I get it right, I get a huge confidence boost. Too many wrong questions makes me want to go off into a corner and cry, but otherwise I really like this approach to learning. It really solidifies your knowledge, and I would rather get these questions wrong in front of an attending than in front of my it's making me a better future physician, and that's what matters most.

One day left. Thank God. ;)

Wednesday, September 28, 2011

Peds: Day 11

Another day in. I had such a great visit with a little girl who was just diagnosed with acute lymphoblastic leukemia. She's not on my service, but since I have an interest in hem/onc, a resident allowed me to follow a few of his patients. It is the highlight of my time on inpatient so far. Only 2 days left.

Today is national beer drinking day! Usually when I tell mike about a random day to celebrate something, mike makes a rude comment about how we Americans over celebrate everything...(maybe the English under-celebrate everything?!). But when I told him about the national beer drinking day, he immediately said "we're out of beer! I better go get some" and he drove to the beer and wine cellar. Haha sometimes it's nice to celebrate the finer things in life!! :)

Tuesday, September 27, 2011

Peds: Day 10

Finally, a decent day! We were swamped, all day. Between the 4 of my residents and me and another med student (well plus the 2 PA students, but they don't really count ;) ), we had 12 new admits, plus 22 patients on our list prior to the admissions, and a mandatory lecture at noon. Busiest day ever.

I'm on this case now of a cute little kid with infantile spasms...which are not responsive to treatment. The parents refuse to accept the terminal character of this illness, that their child will not get better. I can't blame them, I can't even imagine how difficult it would be to be in their position. But the kid is suffering, drowning in his own secretions, barely able to elicit a cough reflex. He keeps getting aspiration pneumonia due to his inability to swallow, and he is getting them more often. Concurrently, his seizures from the infantile spasms continue to increase in frequency and duration despite our best pharmacologic efforts. His brain is becoming less functional with each day, and the changes are irreversible. So, as I stood there with my attending and resident while we spoke with mom and dad about what are our hopes and expectations for the kiddo, I felt so incredibly sad. Young parents, in love with their baby, hoping that the child they cared for, did everything right for, and love above all else, are watching their baby slowing slip away...but they refuse to give up on him. The odds are most certainly not in their favor, but what else can they do? This is their baby, their whole world, who was born absolutely perfectly and was taken care of perfectly, and out of the blue, he was unbelievably unfortunate, developed severe infantile spasms, and he will have a very-much-too-short life. It is devastating. It must be so hard to be a parent; so many things might go wrong with your child, and your child is your world. Thank god for all of the healthy kids; some parents are luckier than they'll ever realize just to have healthy kids.

I'm happy to see that some of my passion for medicine has come back to me!

(you can tell I haven't been too happy with this rotation --- I haven't posted a photo in over a week!)

Monday, September 26, 2011

Peds: Day 9

I hate this rotation. It can't end soon enough. Beginning at 5 this morning and lasting until 6 this evening, all I could think about was how I couldn't wait to get home and be far away from that horrible place. I have held some pretty crappy jobs in my day (gas station attendant, lawn care, nursing home nurse's aid), but this is worse than anything I've ever done. If all medicine was like this, I would rather deep fry french fries for my local mcdonald's and live in a cardboard box than to work like this. Seriously. I'm going crazy just thinking about the fact that I am paying to feel like this. 4 more stupid days and hopefully the worst will be behind me.

During the first two years of med school, I've heard upper class-men complain about peds...I always thought "what is WRONG with you?! They are cute little kids who need you, that you can hold or play with, and celebrate getting better!". But now I get it. There are the worst kinds of challenges in peds, like convincing a mother to care for her child properly, or reassuring her that no, your kid is not sick, he's been faking this stomach ache for a month and you got a full abdominal workup that showed nothing except how gullible you are. But the diseases aren't interesting; colds that get fairly bad so they come into the hospital to be observed and put in a room with humidified air; asthma exacerbations that go away after some albuterol treatments; newly diagnosed doesn't feel like medicine, but more like social work...and that is one of the many jobs I could Thank god there are people out there that can take care of the social issues that make life's just not my thing.

So what did I learn in the past week? I love kids (seriously, I do). Bad parents make life miserable for more people than just their kids. I need to be intellectually challenged or I am a Grouchy Gus. and (I already knew this, but) I hate sitting around and doing nothing, waiting for something to possibly happen that I might need to be around for.

That being said... Tomorrow is a new day; I will put a smile on and I am going to do my best to get as many good experiences from these last 4 days on inpatient peds as I possibly can! Thanks for bearing with me while I deal with the ups and downs of medical school...!

Sunday, September 25, 2011

Of course I would get some sort of sickness from the kiddos after only a week with them. I've spent the day being completely unproductive, just watched some lecture videos and read some pediatric case files, but I have such a long list of things to do it's crazy. How are we to shove all of pediatrics into 5 short weeks?! I'm 2 weeks in, nearly to the halfway point - that's crazy! Can't wait to have this rotation behind me...!

On the plus side, the green card is nearly ready to be sent out. Just waiting for the civil surgeon's blood test results and we need to get a few official copies of a few things and it will be out of our hands...Hopefully it will be sent out before Saturday!

Saturday, September 24, 2011

Peds: Day 7, 8

I've been following this 9 month old patient with failure to thrive. She is in the less than 3rd percentile for height:weight for her age, and her head circumference is also below the 3rd percentile. She has a nervous system dysfunction (hypoxic-ischemic brain injury or possibly cerebral palsy), and her development has been far delayed. Currently, she is 4 months old developmentally, as she cannot hold herself while sitting, cannot roll over, and cannot visually track objects. After some investigation, we have decided that the main factor contributing to her failure to thrive is that she simply isn't being fed enough. This is the number one cause of failure to thrive in America. It's not out of neglect or punishment, in this case it is out of the lack of education on how to feed a baby. Mom just lets her baby sleep for 12+ hours without offering a bottle. When she feeds, she feeds one small bottle without offering more. She has not started feeding solid foods yet. So of course the baby will fail to thrive without enough intake. Babies need about 125cal/kg/day in order to gain 10grams of weight per day. This particular baby was receiving about 25oz of formula per day. Since there are 20cal/oz formula, we can find that this baby was consuming 500calories per day (25oz x 20calories/oz). Since she weighed 7.5kg, in order to gain 10grams of weight per day, the baby needs around 935 calories/day (125cal/kg/day x 7.5kg). That puts her at a significant deficit in caloric needs, so it is not surprising that she is failing to thrive. The next thing we did was educated the mom about how to care for her baby so that she may reach the developmental milestones that we expect for her age. THIS is why I don't like pediatrics. Parents have no formal education on how to be a good caregiver, and the child suffers. Even after giving advice, parents often think they know better, and disregard what we have to say, and the child is the one who suffers. It is so unbelievably frustrating. It is so hard to be a patient advocate when the patient's caregivers refuse to be on the patients side by refusing our advice or guidance. For another example, a kiddo with a history of seizures was meant to have an MRI as an outpatient. The mom didn't think it was necessary, and now the kid is in the hospital after having suffered an embarrassing seizure at school, which could have been prevented with proper diagnosis and medication. The list of examples is really endless, and I've only been on inpatient pediatrics for a week. This is definitely not the career for me. Advice and education is at the heart of being a physician, I know I couldn't stand being ignored and disregarded by parents and then watch the kid suffer because of it. Thank god there are people out there that can handle it and do well to education parents on things that would most help their child, but I know that I am not that kind of person. I love kids, I just can't stand bad parenting... ;)

1 week left of inpatient pediatrics, then 2 of outpatient!

Thursday, September 22, 2011

Been a busy two days. Work 6-5 then I come home exhausted... I don't remember surgery being this tiring. I want to say more but I am knackered. Long post tomorrow to make up for it- or maybe even 2 separate ones if I'm feeling up to it! Big day tomorrow, can't wait to have some fun !! :)

Tuesday, September 20, 2011

Peds: Day 6

Worked 6a-5p. Seriously, the worst day of my third year so far. After getting there early, I sat around and waited...we didn't actually round until about 7 (nothing upsets me more than sitting around doing nothing - or what Mike calls it, "faffing" around). Then I went to round on my ONE patient. ONE. Finished with my ONE patient in about 15 minutes, waited for 2 hours to do rounds with the attending. Rounded, and we didn't have any teaching points. None. No pimping, no explanation, no thought-process. Had a tiny lecture on fluids (seriously, its not hard people! 4ml/kg/hr for first 10kg, 2ml/kg/hr for the second 10kg, then 1ml/kg/her thereafter - it seriously can't be any simpler). Then we learned how to write an admission and a discharge order, so we are able to fill it out for our residents. I like to call this kind of work "busy work" --> where I am doing someone else's responsibilities without receiving any form of compensation in return. Obviously I'm not getting paid, but I do expect some teaching from you in return for doing some of your work. I don't normally mind, but I have learned nothing from any one today except from my patients and my own research. When I'm paying about $10/hr to be there, I damn well expect a little bit of teaching to go on. But not today. And then I had to go in and talk to a young girl who tried to overdose on antidepressants, which was absolutely heartbreaking. Finally, the day ended after I listened to a few physician assistant students tell me how they are better than not only nurse practitioners, but MDs as well. I mean, the clue is really in the name ---> physician ASSISTANT, so you can stop with the charade of placing yourself at the level of an MD. I know that's harsh, but I spent an hour biting my tongue as they explained how they are so useful, money-saving, smart, and how they are the next "step forward in healthcare" I am allowed to be a little offended. Incidentally, I would place NPs ahead of PAs, as they are at least the top of the nursing profession, can manage their own clinic, and (in most states) don't need to be supervised by a physician in order to work. I don't think the PA students would like me very much if I admitted that to them, though...! And these PAs are in for a very long life if they refuse to get along with doctors...

Ok. Rant over. I don't like to complain, and it's rare that I do, but it has been one of those horrible days. I am not enjoying this rotation in the slightest. I can't figure out if it's because of dealing with kids, or because of the residents, or the attending, or the team, or the hospital, or what it is. All I know is that I don't look forward to going in to work in the mornings, and this is the first time I've felt like this in a very long time. I guess things can only get better...

On a positive note - I scheduled for my fourth rotation last night! After Peds and OB-GYN, I will be doing...Internal Medicine!!! I got into the one I wanted...should be fun! :)

Monday, September 19, 2011

Peds: Day 5

My first day of Inpatient Peds is complete! Was in from 8-6...hours look a lot like surgery, I'm not keen! Pretty friendly real complaints as of yet.

I have seen so many kids with croup its crazy. It's the beginning of the croup season, and we have a lot of kids on our service with it. I also saw a lot of kids admitted due to asthma exacerbation. One child had Acute Disseminated Encephalomyelitis due to a previous viral infection...kinda scary to think of the illnesses that some children have even if he/she is otherwise healthy.

My patient is a cute little 5-month old boy with intermittent, severe abdominal pain. He vomited 8 times prior to admission (which happened early this morning). His CBC was within normal limits. He currently is running a fever of 103, and is smiling and mobile until a painful attack makes him cry and pull up his legs towards his abdomen. He has not had a bowel movement in 3 days, and his urine output is decreased despite adequate rehydration. Our main concern for this little boy is intussusception, which is a "telescoping" of the intestines. This happens when a portion of intestine, most commonly the end of the small intestine, telescopes into the lumen of the next segment of bowel, most commonly the cecum, which can lead to painful episodes and bloody/mucous stool (the pathogomonic "currant jelly stools"). This is often a clinical diagnosis, and the treatment is to give the patient an enema, which works by using a retrograde force and attempting to push the intestine back into its proper place. After obtaining an abdominal x-ray showing bowel distension and lack of air in the distal colon as well as performing an unremarkable abdominal ultrasound, we went ahead with the barium enema. When I left today, it was said that the enema study did not support the diagnosis of intussusception, but his temperature was going down and he seemed less fussy. I'm not sure what is going on with him if not intussusception; the differential diagnoses include gastroenteritis among others, so that is always a good fall-back diagnosis. Either way, it was a good way to re-enforce the pathophysiology, etiology, presentation, diagnosis, and treatment of intussusception.

I'll be getting up for work at 6a for the next two weeks - I think I did this to myself when I said how happy I was to have the crazy surgical hours behind me!! Speaking of surgery, I'm happy to say that I did better than I expected on the surgical shelf exam. I'm starting to feel like I really will be a real doctor someday...! ;)

Sunday, September 18, 2011

a MAZE-ing weekend

Forgive my cheesy title, but we went through a huge corn maze this weekend! We went with Gina & Ben after a day of shopping. It was fun, figuring your way through the maze and getting to the checkpoints. I love doing things that are active and I love the outdoors, especially with the fall weather sneaking in.

Mike & I went to watch his kids play soccer on Saturday afternoon before we went to Zinful for dinner. It was surprisingly classy yet decently priced. It just opened up about a month ago, but I think they created a good niche for them to succeed with...they have wine tasting, lots of different types of beer, and a cigar room. We will definitely be back (and uhm it will probably be already this next coming weekend!). Oh yeah, and they finished with a surprise dark chocolate covered truffle for dessert - what a perfect finishing touch.

The perfect beer for the Vespa enthusiasts:

Mike pours the perfect pint

 Dr. Lossen's Riesling + Seafood Flatbread ---> yummmmmm

Chocolate Truffle for Dessert

Just worked on Green Card things today, from 10-7. It really is nearly finished though, I just am so OCD I want to make sure everything is just perfect and in the correct order, easy to navigate through, well put together cover pages, ensuring enough documentation, and reading through the forms for accuracy time and time again. I'm starting to think we might not need to be interviewed if I send it in just right - wouldn't that be nice! :) I even actually cut the checks and fore-dated the signatures for Friday, when we plan to send the whole thing off. It is going to be such a great day when it all gets out of the apartment and into the proper office!

I think I need to post something medicine-related from the weekend, so how about this: Marley gave her ducky an emergency tracheotomy (a little right of midline, but she managed to make it work!)haha  ;)

I start my first day on Inpatient Pediatrics tomorrow morning...I don't really like not having any idea what to expect, but it will be ok. I'm starting to get sick of all of the "newness" of third year - I would like a bit of familiarity back in my life. I think signs are pointing towards patient-care that involves caring for the patients on a long-term basis. I guess we all fear the unknown, afraid of what we don't know...I'm trying to embrace all of these new experiences with optimism and confidence; things will work out as they should, as they always do.

Saturday, September 17, 2011

Peds: Day 4

Was in lecture from 8-11:30 today. Went over childhood stages of development (Piaget's stages of cognitive development), pediatric cardiology (ASD, VSD, Coarctation, Tetralogy, PDA).

Copied a whole bunch of forms from my parents' previous tax years to use as supporting evidence of financial support for the green card. Seriously took us 5 hours to copy and put them all together properly. But it finally feels like it is starting to come together. I'll explain the whole process in a future post...but suffice it to say that it's a whole lot of work, a whole lot forms, a whole lot of legal jargon, and a whole lot of money in order to apply for permanent residency. Oh and by the way this will only last 10 years before we would need to re-apply or apply for citizenship. Lots of work. The amount of stuff I need to do to live in the UK is laughable - pretty much just need my MD and my husband at customs in the airport...actually I would only need my MD, but the husband might make the process a bit quicker. Hilarious, the difference between the US and UK!

After working on that until late in the afternoon, Mike & I went to get our hair cut. I've been so busy, between studying for the Step1 and then my Surgery Clerkship that I haven't had the time or desire to go and get my haircut. So it has been a while....

Before:                                                                                                                                    After:

Then went for a few drinks and listened to some music at a lounge bar. I even got a few genuine smiles and laughs out of Mike, I love it when he forgets how much he misses home and allows himself to be happy here! It only happens once in a while, but those glimpses of his normal, happy self make me fall so in love with him all over again...

My Lemon Drop Martini:

Friday, September 16, 2011

Peds: Day off

Lucky, lucky me... Had a whole day off today! So mike & I got a lot of things done together. We even drove to my mom and dads house to pick up a few forms and of course to chat with my parents and spend some time with our niece and nephew. I just love my family. It's so nice to come home and just feel totally comfortable. A cup of tea with my mom is one of my favorite things in the world.

Happy couple! :)

Realize mike and I drove over 3 hours today before we noticed that the radio wasn't on. We love our music, too... I just love that we have such good conversations that we are so involved in that we don't even notice that the radio is off! And we love our music, we always have an iPod on or pandora playing. It's so nice to have someone that I can talk to for hours and hours over many years and still not run out of things to say. I'm so happy to have found my better half.

Returned home with a totally unhealthy greasy disgusting bucket of kfc chicken. We seriously never eat crap food, but it's hard to get relatively low carb take out anywhere so we settled for fried chicken. Got in the apartment just to find that marley took full advantage of the opportunity to ravage the trash bag we forgot to throw out... We're in for a long night with marley, the  baby is going to have a rough night tonight...

Wednesday, September 14, 2011

Peds: Day 3

Third day of peds. Did a newborn exam this morning, went thru a few lectures, then did a simulated pediatric emergency. Was a great time!

Big day today - I became an official member of the st rose church I have been attending for the last year. Was really sad to feel like I've left my home church. My family and I have always been so active in our church, so it's hard to leave it behind and commit myself to another parish. I've decided to finally move over to their parish since I will most likely be attending mass more often there than at my home, since 3rd year is so busy and demanding.
 St. Rose of Lima
 Inside view of St. Rose
(Photos are from

Mike and I want to have our wedding ceremony at st rose. Now that I'm a member, I'm hoping they will let us hold our most special moments of our most special day with their church. Fingers crossed cos the church is just beautiful and feels like my home church, it would be perfect!

Was surprised to find a letter of appreciation from my surgical clerkship director regarding my presentation. She was so pleased with my work and dedication to exceeding in all aspects, especially education of peers, that she gave me that letter and added it to my permanent medical education file. So nice to know that my hard work is not going unnoticed! :)

Tuesday, September 13, 2011

Peds: Day 2

Another day in peds. Was in a special needs clinic for the morning, speaking with and examining premature toddlers. Then in the afternoon I did a few physical exams on a few babies. Pretty good day, love the laid back feel.

We went on a walk with Marley then mike made me sprint a mile with him (my average speed is about 6.5mph and mikes natural speed is more like 10). Finished with a cool down swim in the pool... Total workout time was a bit over 2.5 hours. Nice to spend quality time with mike and marley as well as improve our health and fitness.

After looking thru my blog I've found that I much prefer when I have a photo or two that accompanies my thoughts, so I'm gonna try and include more of them.

I set up an appointment to see one of the deans of the medical college regarding how to go about doing my third year elective in england. They don't typically have that option available to students, but I'm hoping they'll make an exception considering my situation is somewhat unique. First step towards residency in England has been taken! Pretty exciting :))))

Monday, September 12, 2011

Peds: Day 1

Today was my first day on peds... Was just in lecture today from 8:30 to 3:30.

Quote of the day from an attending: "I don't like kids. They're dirty, snotty little monsters... I promised my husband, as a pediatrician, I would never wear anything Mickey the mouse or winney the pooh crap on my clothes or little cutesy things on my stethoscope. What I love about peds is how a kid can be sick and not complain about it. Adults get a cold and they need to take a week off of work. Kids get sick, get better, and get on with life, forgetting all about their time being ill." I am on her side on that one haha I'm so happy the pediatricians aren't all cutesy little children in adult, doctor bodies! Had a few laughs today, too. They seem to be so much more laid back than what I'm used to. Totally looking forward to feeling comfortable and encouraged throughout the clerkship!

We watched Mike's team play one of their rivals tonight. The kids played better today. They won 6-0, but could have scored several more goals. Marley and I had a good time talking with some kids during the game. Marley is being so spoiled lately, but the weather has been so nice I can't help but get in as much time outside as we can while we can still enjoy the hot weather!

Loving every minute of life. So thankful for everything I have, especially my wonderful family and friends. Love you all! :)

Sunday, September 11, 2011

This Has Gotta Be the Good Life

Another great weekend has come and gone!

Friday was spent with Sangria, board games, wii, and a movie. We watched Water for was a pretty good movie. I mean, I fell asleep before it finished, so I need to watch the end of it before I can really know if I liked the whole movie or not! ;)

On Saturday, Mike & I watched the Liverpool game then went to watch one of Mike's teams play. The kids were pretty good, some of them have such good insight in the game...Some room for improvement, but that's what Mike's there for. And he is a great coach. He is so good with kids, every parent tells me that as if I didn't already know how patient he is, how good he is at explaining things and making every drill fun. All I have to do is look at him while Alex or Katelyn or Luke is around; he will make a great dad. What am I saying? He already is a great dad - Marley thinks the world of him! ;)

 We went out to eat at a Mediterranean restaurant with Gina & Ben on Saturday night. So yummy!
 Another great night out with our friends. If only there were nice places to dance the night away here, then we'd be all set!

Today, Mike & I took Marley to a "Bark for Life" event - it's an American Cancer Society "Relay for Life", but for dogs. It was so cute! Marley had such a good time, running around in the rain and puddles, meeting a whole bunch of new dogs, and sniffing loads of new smells. After about 3 hours there, she came home knackered! It was a nice way to spend the 10 year anniversary of 9/11, remembering how we spent that day and they days following. It's interesting to see how much of an impact 9/11 made on Mike, despite the fact that he experienced it from across the pond. Somethings are so powerful they transcend our national patriotism and instead pull us together through our common ties of humanity.

Spent the rest of the day doing those odd jobs that I haven't had time for in the last 10 weeks, then worked on some more green card stuff.

Tomorrow marks the start of my second clerkship - Pediatrics! I don't know how much I'll like taking care of sick kids (I like healthy kids!), but I am excited to start on the next phase of my education! :)

Final Thoughts: Surgery

 My first clerkship of third year (surgery) has come to an end...
  • 10 weeks, 60 days, 529 hours of work in areas ranging from Trauma, to Surgical Oncology, to General Surgery in a rural area. 
  • Working at my medical school's hospital, I averaged over 69 hours/week.
  • Working at the rural hospital averaged 28 hours/week. 
  • I enjoyed 10 days off in the last 70 (that's 1 day/week).
  • I completed 3 nights on call, which entailed working about a 30 hour shift each time.
  • I studied surgery outside of work a total of 166 hours.
  • My total work in surgery over the past 10 weeks is: 695 hours in 10 weeks (69.5 hrs/week...10hrs/day).
What I LOVED about surgery:
  • Being able to fix someone's problem in a very short amount of time is so rewarding.
  • Physically taking cancer out of a patient's body.
  • Short rounds on very grateful patients.
  • A great deal of respect is given, based upon the surgical hierarchy (med student < intern < junior resident < senior resident < chief resident < attending < chief of surgery). I like that you must earn respect, and it is slowly given as you prove your worth.
  • Free food and drink in the surgeon's lounge just because you are, well, a surgeon.
  • There are only like 10 medications you need to know - a few pain meds, a few antibiotics, and a few anesthetics (Percocet, Vicodin, Ancef, Bactrim, Metronidazole, Clindamycin, Cefotetan, Lidocaine/Epinephrine, Zofran, maybe a few others...).
  • There can be a huge variety of problems you see on a day-to-day basis, so every day is different (even if you do 8 cholecystectomies in 1 day, no two surgeries will be the same)
What I DIDN'T love about surgery:
  • Surgery = Life. 
  • Mistakes happen. Even the very best surgeons can make a mistake and the results can be dire. 
  • Even if there are no mistakes and the surgery goes perfectly well, some patients will develop problems due to the surgery and may never recover.
  • It's a hell of a lot of pressure, it is really life-or-death work.
  • Unbelievably male kind of feels like you've stepped back in time to the 50s, when men ran the show. The younger surgeons are less like that, but the older ones are still very much "alpha males".
  • Ridiculous amount of hours worked.
  • Skipping breakfast...lunch...then dinner because you're in a complex surgery.
  • Putting my hands in a Hep C or HIV positive abdomen (My thoughts during the entire case are something like this: "I hope double-gloving is enough to keep his blood away from the cut I have on my hand...I hope I don't get a needle stick...Please, don't drop that scalpel near me...that surgical nurse better hand things to me absolutely perfectly so nothing comes near my skin...Is this eye mask really enough to keep a squirting artery from hitting my eye?...I don't think I'll ever be able to scrub hard enough or long enough to feel properly clean after this case...") And while those thoughts continue to flood my mind, I have to pretend like it doesn't bother me in the slightest, or the surgeons will think I'm a total wuss.

I ended up liking surgery so much more than I thought I would! I came into this rotation thinking that I'll just get the worst out of the way first, because I'll be so excited to see patients that I won't mind the hours and the surgeries as much. Turns out I enjoyed the surgeries, and even the hours ended up not being that bad. I don't think it's the career for me, but I enjoyed my time and have a lot more respect for surgeons now that I have somewhat of a feel for what they have to go through to get where they are.

Saturday, September 10, 2011

Surgical Shelf Exam

My very first clerkship is officially finished! I took my surgical shelf exam yesterday.  A "shelf" exam is an exam that many med schools purchase from the National Board of Medical Examiners (NBME) that test materials presented during the third-year clerkships. The questions are metaphorically pulled from a box on the "shelf" and thus the name "shelf" exams. They are used by participating medical schools to compare their students to others nationwide, as these exams are not scored by the school but by the NBME. The standardized exams give residencies throughout the nation a better understanding of where their applicants rank, but I'm not sure how much weight shelf exams are given in comparison to the Step1 and Step2CK/CS and the interview.

The exam had a lot of questions regarding vascular disease (I of course haven't seen a single vascular case in my entire 10 weeks of surgery), but only a few regarding cancer staging and differing treatments suggested based upon stage (which I of course spent over 3 weeks on and then memorized prior to the exam). Overall, I feel like I did fairly well. I've said it before and I'll say it again, it is so hard to achieve any grade below 100%...I know, it's impossible for anyone to know everything, but for some reason I expect perfection of myself. So I am eternally disappointed with my results, I leave every exam upset by the questions that were just out of my reach. These questions are always regarding some topic that I learned ages ago, haven't thought about since, and somehow needed to recall that information to answer a question on the exam. It's so frustrating, because I KNOW the information is in there, somewhere, but I just can't get to it. Frustration. Thankfully, this is happening less often as my understanding of medicine increases.

So, after spending 2.5 hours answering 100 questions regarding surgery, I came home to a pitcher of sangria, ready and waiting for me to celebrate finishing my first clerkship! Mike even made me some snacks that I love, he is such a supportive fiance. I love how he's always ready to celebrate every little step I take towards becoming a doctor, and how he's there to listen to my frustrations when things aren't going so well, and how he seriously thinks I will be the best doctor in the world. I could never get through the perils of medical school without him, and I am so thankful that he is here to support me through the good times and the bad! :) :) :)

Thursday, September 8, 2011

Surgical AHEC: Day 12

Welp, folks...the day has finally come. My last day of surgery. Leaving the OR today, I felt a little sentimental; I won't be involved with surgeries ever again. That was it. 10 weeks of it, that's all I will really see of it for the rest of my life. Bittersweet, another small chapter in my novel of a time involved in becoming a doctor is finished. Well, nearly finished. I would be remiss if I forget to mention my shelf exam that is tomorrow, I still need to complete that before I can say that I am officially finished with surgery.

It's Gina's birthday today! After I finished my last day of work at the AHEC - I got to help do a colonoscopy and an upper endoscopy today - I came back up to my apartment, studied for a few hours, then went out to eat for Gina's birthday. We went to this mom-and-pop Italian pizzeria, it was pretty good. Yummm the thin crust pizza was just loaded with fresh mushrooms, it was sooooo tasty! (side note: just realized I mentioned colonoscopy and a tasty pizza in the same paragraph - I must be getting a bit too comfortable with the icky-stuff in medicine!haha)

Anddddd while in the middle of dinner, I got a phone call (I've been waiting for a certain phone call, so I answered), and the woman on the other end addressed me as "Doctor". Used my full name and everything. My first phone call addressing me as a doctor... Made.My.Day. It's like another small victory, another step towards getting that MD... Sometimes I get so caught up in learning and revising that I forget that I WILL be a doctor (and fairly soon as well!). :) :) :)

Happy birthday to Gina, one of the most caring, unselfish, kind-hearted, and genuine people I have ever met in my life! I am so lucky to call her my best friend!!! :)

Wednesday, September 7, 2011

Surgical AHEC: Day 11

Rounded from 8-9, then I was in clinic today from 9-11, and then went to help do a subtotal gastrectomy with a different attending physician until about 3:30. I was complemented on how well I tie knots ("good technique"); to get a complement from a surgeon is a total honor, they are not the kind of people that like to make others look good. So I was asked to tie off a few arteries...must mean I am doing a good job if he trusted me with putting in tight enough and solid enough knots that the artery won't leak!

One thing that was suggested to do when you start clinical years to count something... Like, count the number of times you see this rare disease, or this type of presentation for this disease, etc. I've decided to keep track of how many times I am mistakenly called a nurse versus how many  times I am mistaken for a doctor. I can finally say that I have been called a doctor more times than a nurse by a close count of 4-to-3. Most people don't expect to see a female surgeon, so I can only assume that's the cause of the misconception..! But I LOVE when I sit and talk with my patient, answer their questions, and then follow the attending into the room for his interview only to see that I've already answered everything (and answered them correctly), which must make me look like I know what I'm doing! ;) Or maybe I just get lucky, as the famous surgical saying goes, "even a blind squirrel finds a nut once in a while."

One.Day.Left. Holy cow. Where have the past 10 weeks gone??? And, more importantly, where the heck has summer gone?! I'd like those hot days back again, please! ;)

Tuesday, September 6, 2011

Surgical AHEC: Day 10

Seriously: what a FUN day!!! AAaaahhh I've missed work after having a 3-day weekend away from it. I just love how complicated medicine is, and how rewarding it can be when things work out as planned. I was in from 9a-4:30p, did rounds then performed several surgeries. We did an incisional epigastric hernia repair, pilonidal cyst drainage, 2 laparoscopic cholecystectomies, and 1 laparoscopic converted to open cholecystectomy. I took out 2 gallbladders today, I pushed in a hernia sac prior to suturing it, and I closed the incisions with my single interrupted inverted suture skills.! I mean, how many people can say that they made people's lives better just by doing their job?! I LOVE this, I just LOVE medicine. I have never fit in to anything as perfectly as I fit into this; I know that this is what I was put on earth to do, and I could not imagine doing anything else! If only I were making the money that my superiors are making, then I would truly be living the dream, but I have to say, I already feel as though I am. I don't need the money to be happy, I'm doing what I love and who can ask for anything more??? (OH and I happen to have the world's BEST FIANCE, how lucky am I?!)

I'm trying SO HARD to study for this shelf, but it's not easy to find the time to revise after a full day's work. I know, I know, I've said this all before. But really how many times do I really need to read about fluid resuscitation, nutrition, wound healing, cholecystitis, etc etc etc. Apparently, several more times than I have done. There is just so much to know, so many ways to understand it through and through.

2. Days. Left. I honestly can't believe that I'm going to say this, but...I am soooo definitely going to miss getting my hands messy in my patients bellies and putting in sutures and *curing* their illness (in many cases). I can't believe how much I have enjoyed surgery, I am amazed by how much I actually like it when I thought for sure that I would *hate* it!!! 2 days left to be the best surgical student I can be; I'm gonna go out doing my best! :) :) :)

Monday, September 5, 2011

Labor Day Weekend!

What a gorgeous 3-day weekend!! The sun was so hot and beautiful, such a perfect end to summer! Enjoyed the 100+ degree weather with a few runs in the park, it was brilliant. I'm going to miss this weather once fall rears its chilly head...but I do have a few ideas of new experiences for Mike & me during the fall months; hopefully my life will be a little less chaotic once surgery is over and I'm on to pediatrics.

Just did some proper cleaning round the apartment, took us 2 days to get it all sorted. What.a.mess. Went out for a nice dinner, just the two of us. Then we met up with Gina & Ben at a pub near their house and had a few drinks and lots of laughs.

We also finished up our photo album, it looks great. Mike has spent so much time on it, putting all of these little touches onto each page, making them look perfect. He is so crafty, who would have ever guessed?! ;)  Then to finish the weekend, we dived into the green card to-do list head first. We have a lot to do, but I know it will end up being perfectly put together, extra touches and personal additions that will make the whole process go as smoothly as possible. No need for a silly lawyer when I'm around!! ;)

Ok, seriously, how funny is this dog?! 
She's so cute sometimes; I can't hardly take it!! :)

I've been studying for the shelf I'll be taking on Friday, its crazy how you can feel like you have so much to learn even after all these years of studying medicine! I'm waiting for my brain to just "click"; What I mean is that for the first 2 years of medical school, we learn the disease from the beginning onwards. For example, we learn that Appendicitis has peri-umbilical pain to begin with, followed by RLQ pain and tenderness, and rebound tenderness, particularly around McBurney's point. There may or may not be a fever, nausea, vomiting, diarrhea, or leukocytosis. To cure, you remove the appendix and on pathology you see that half the time it is appendicitis, half the time it isn't. Now, however, we learn it backwards: A patient comes in with nausea and a slight fever, along with abdominal pain. May or may not have pain specifically in the RLQ, doesn't remember if his umbilical area was painful before he noticed the pain he's experiencing now. From that, you've got to make it through a differential diagnosis in your head: pretty sure it's appendicitis, so to prove it we have to do some sort of imaging (CT with contrast is best), which may not prove to you that it is or is not appendicitis. So you look through your differentials...diverticulitis? kidney stone? hernia? testicular torsion? perforation with fluid filling the right colic gutter?...just to name a few. So then what? Take out the appendix if I'm pretty sure it was appendicitis, and take a look around the area while I'm in there. But can you see the different way of approaching the problem? It's a total flip-flop from what I have been learning the past 2 years, hence why I mentioned that I'm waiting for my brain to just "click" and allow things to flow in the opposite direction. I know the information is all in there, somewhere, it's just difficult to retrieve it when the questions and information is presented to you in a new and intriguing way. Things are starting to properly "click", but oh my is it frustrating when you can't get to the information that you know you have stored somewhere up in that skull of yours. The different attendings have all warned us of the new way of learning, that's the fun of the 3rd year of medical school. We will all have that "a-ha" moment, when things just make sense both ways, and diagnosis and treatment becomes such a fun thing to do. It just takes several months for us to get there...hopefully it will come sooner for me than later, until then I'll keep revising and presenting scenarios in different perspectives to try and get my mind to switch over to real-life mode!!!

Saturday, September 3, 2011

Surgical AHEC: Day 7, 8, 9

Wednesday and Friday were clinic days. I saw a variety of patients, the most common complaint involved gallstones/cholecystitis. I typically run through an HPI and physical exam on each patient, present the patient to the attending, and then observe the attending elicit an HPI and physical exam, and then he proceeds to speak about the risks of surgery, how the procedure works, possible complications, what to expect post operatively, and so on. I think I can recite his speech on cholecystectomies by memory, I've heard it so many times!

On Thursday, we took out a lymph node from the groin to check for a lymphoma, did a couple of hernia repairs, and 2 lap cholecystectomies. I'm getting better and better at my sutures and knot tying. I have a feeling that I'm going to miss it when surgery is through... I also got to put the gallbladders into the bag with the instruments and remove it from the abdomen. Pretty fun!!! I'm really enjoying this time with my attending at a rural hospital; they have a life, they are really respected, and they above all else love what they do. Such a stark difference to what I've seen in my first rotations, where the doctors eat, sleep, and breathe surgery.

One more week to go on my surgical rotation! I can't even believe it...

Friday, September 2, 2011

Surgical Oral Exam & OSCE

On Tuesday, I had my very first oral exam. It was terrifying. I sat down with a plastic surgeon (just my luck...) and talked about lots and lots of different things, ranging from melanoma to lung cancer, cholecystitis to upper GI bleeding, colon cancer to breast cancer, and a lot of random surgical stuff in between. It's hard to know what they want to hear; given such an open ended opportunity after being told to "tell me about melanoma" means that I could go any direction with that topic - but where did the surgeon want me to go??? Details about specifics, or broad overview, or just the concepts of pathophysiology and treatment? That was the worst part of it. Oh, and she asked me a LOT of specific number questions ("If the primary superficial sclerosing melanoma lesion is on the face and is less than 1 mm in size, what does that indicate? What treatment would you suggest? What is the prognosis? How clean must your margins be?"). I talked to a few friends who took the orals the same day as I did, and I have heard that they went through the basics, the principles, the concepts...not the specific details and cut-off numbers. This surgeon was FULL of number questions...Like what is the necessary FEV1 in order to attempt a lobectomy versus a pneumonectomy? I'm not good with numbers on a good day, so on exam day you know I'll mess it up. But I gave broad concepts, and my numbers were mostly spot on (or nearly spot on...). It was rough. I did ok though, certainly not a fail, but I always feel like I'm a failure if I don't get 100% of every question asked correct. Maybe I'm a little too hard on myself...but I just expect me to be perfect and I don't accept anything less. That's a hard thing for me to overcome; no one in this world is perfect, so I have to accept that I cannot know everything, and it's ok to get a few things incorrect...Being a perfectionist, it's hard to accept that.

I also had my first OSCE or Clinical Exam. I had 2 standardized patients to take a full H&P on, perform an exam, speak with the patient about possible diagnoses and tests we'd need to run, and write a note documenting the encounter. My first standardized patient had diverticulitis, the other one had acute cholecystitis. I scored noticeably higher than average on my clinical exams. I'm always happy to do well on the Clinical Exams, as that is what my future will be full of.

I'm happy to have that done and over with. Only my shelf exam to take next week and I'll be finished with my first clerkship, 10 weeks of 3rd year will be complete! Seriously: Where Has The Time Gone?!?