Thursday, February 23, 2012

Why Oncology?

As I perused the internet this afternoon, reading up on some medical blogs and career advice, I stumbled upon this article entitled "Why I Became an Oncologist". This article really resonated with me. When attendings ask me "why are you interested in oncology?" with a puzzled look on their faces, I have a tendency to simple say "I love the patients", as if that answer is a crystal clear explanation. This article eloquently explains what I mean when I say that simple phrase. Secondarily, I am absolutely fascinated by cancer; it is frighteningly interesting. Also, as I have said before, I love the idea of passing on my knowledge to future medical professionals as an attending. This little blog post has me thrilled about my choice of career - I just know that I will find work so fulfilling and meaningful as a medical oncologist.

Please, enjoy.


Cancer doctors tend to get to their profession in one of three ways. Some are drawn in through their love of cancer science. Cancer has always been something like a cobra to those who study it: dangerous and beautiful and endlessly fascinating. Cancer is a universe. One can spend an entire life exploring it without ever getting bored, for the biology of cancer is the biology of life.
Some doctors are inspired by a great teacher. Medicine is still a profession dominated by old-world apprenticeships, where a mentor’s passion can be transmitted to a new generation. I have known several oncologists whose careers turned on chance encounters with inspiring professors.
Others get there by way of their patients. I’m one of these. When I was a resident, cancer patients were the ones who touched my heart. In fact, I can remember the very moment I started my path to becoming an oncologist.

I was an intern at St. Louis University, a brand-new doctor, with my white coat still fresh and creased, when I first met Carmelita Steele. Carmelita was in her early twenties, married, with (as I recall) two young children. She came to our hospital as a transfer in the middle of the night. She had undergone a routine dental procedure, and after her surgery had first oozed, and then gushed blood. By the time she got to us she was severely anemic, and had a low platelet count. There was a very real concern in those first few hours that she would bleed to death.
We worked through the night stabilizing her. Her veins were hard to access–they had all been used up during her time at the other hospital. In those days (the late 1970's) we lacked modern venous access devices, and I remember it taking a frighteningly long time establishing an intravenous line. Through it all I spoke to Carmie, who was a cheerful if appropriately anxious African-American woman, somewhat overweight, proud of her children and her loving family. We poured several units of blood into her that night, bringing her back from the brink.
We spent the next couple of days establishing a diagnosis. She had Acute Myelogenous Leukemia, then as now a dangerous disease requiring toxic chemotherapy to clear the blood and bone marrow of treacherous cells. I learned the diagnosis shortly after morning rounds. Her staff doctor, an elderly hematologist (or so he seemed then, though I am now about his age) would, I discovered, be off campus until the following morning. I knew that Carmie and her family were desperate for news, so I phoned the staff physician and asked if it was OK for me to speak to her. He agreed.
I had never told a patient that he or she had cancer before. I sat on the edge of her bed and told her that she had a type of leukemia, that it was very dangerous but that it was potentially curable with chemotherapy. I told her that we would be starting treatment the following morning, as soon as her staff physician had a chance to go over the drug regimen with her.
Carmelita had sat quietly while I spoke, a sad look on her face. When I was through she said, almost in a whisper, "Doctor Sledge, who will take care of my children?"
It was the last thing I was expecting, and it was thoroughly devastating. I did not know how to answer. Today I hope I would do better, but at the time I was in my mid-twenties, just a few years older than Carmie, and I did not know how to answer that question. I stammered something, barely maintaining my composure, and then left her room and hid in a stairwell for a half an hour sobbing.
The next day we started her chemotherapy regimen, full of hope. I spoke to her regularly, and to her family. Her husband, a quiet decent man, stood by looking worried. Her mother, a medical technician who understood leukemia, rarely left her daughter's bedside. They were the sort of family we all should have.
For several days things went well. Then, as her blood counts plummeted in response to the chemotherapy, she developed an infection in the area of her intravenous line, followed by sepsis. Her blood pressure dropped, and her breathing became rapid and labored. She was transferred to the intensive care unit, intubated, and treated with broad-spectrum antibiotics. Sometime in the middle of the night, disoriented and alone, she pulled the breathing tube out of her mouth. Though she was quickly re-intubated, things rapidly went from bad to worse, and she died the following day.
I went home that night in a furiously angry mood. I was supposed to be going out with my girlfriend, but in my grief and guilt I simply could not think straight or act civil, so I begged off. I relived every moment of her care: what had I missed, what could I have done differently, what foul-up had I committed that kept a 22 year-old from taking care of her young children? It is the arrogance of interns that they believe that acute leukemia would turn out differently if only they had gotten a little more sleep.
A few weeks later I got a call from Carmelita's mother. She wanted to meet with me. I agreed, with real trepidation. The wound was still too raw, and there was part of me that feared she might hold me responsible for her daughter's passing.
But she was as gracious as I could ever have imagined. I have three sons, all in their twenties, and if one of them died of leukemia I do not know how I would handle it. Poorly, I suspect. But she was dignified, pleasant and grateful. She told me that Carmie, before she had died, had told her that, come what may, she wanted to give me a gift to thank me for my care, and for the hours I had spent with her. She then handed me $40 and told me I was to spend it on something fun. Carmie had wanted it that way.
My patients, starting with Carmelita Steele, have taught me so much about what it means to be a good doctor and, I hope, a good person. I am an oncologist because of her, and it is a job I have loved for three decades. But Carmelita's question still haunts me: "who will take care of my children?"
There are some debts you can never repay.



Wednesday, February 22, 2012

Final Thoughts: Internal Medicine


My fourth clerkship of third year (Internal Medicine) has come to an end...
  • 10 weeks, 54 days, and 399 hours of work in areas ranging from General Internal Medicine Inpatient,  Inpatient and Outpatient Hospice, Hematology Oncology Outpatient Clinic, Cardiology and Autonomic Dysfunction Outpatient Clinic, and Cardiology Inpatient.
  • Working at a nearby, larger hospital, I averaged 47.67 hours/week. 
  • Working at the Outpatient Clinics, I averaged 25.42 hours/week.
  • Working at my medical school's inpatient hospital, I averaged over 41.9 hours/week.
  • I enjoyed 16 days off in the last 70 (that's 1.5 days/week). 
    • Significantly more days off than usual due to the Christmas Holidays
    • Plus 7 days off for Christmas/New Year (my one week off for the entire 52 weeks of third year)
  • Every fourth day on Inpatient Medicine, I completed "Long Call", which was a 14 hour day (6a-8p).
  • I studied Internal Medicine outside of work a total of around 111 hours.
  • My total work in Internal Medicine over the past 10 weeks is: 510 hours in 10 weeks (52.4hrs/week...7.5hrs/day).
What I LOVED about Internal Medicine:
  • I use my brain all.of.the.time. This is problem solving at its finest. The sheer amount of knowledge one needs to succeed in Internal is overwhelming at times, but it is definitely achievable.
  • There is more than one right way to solve any problem...unless you use mindless algorithms, which suck the intelligence out of medicine and produce a "one-size fits all" workup, diagnosis, and treatment plan for patients. (side note: there is no "one-size fits all" plan that works for everyone, things need to be altered to fit each individual patient if they are to be treated optimally). 
  • 3 year residency. Sorry, maybe you didn't catch that clearly enough: THREE YEAR RESIDENCY! 
  • The options after internal medicine residency are limitless! There are so many fellowships one may complete after board certification in Internal Medicine.
  • This is the pathway to Hematology-Oncology, which is a 2 year fellowship after internal medicine residency. In FIVE years time, I can be a fully licensed and practicing Oncologist, while my peers will still be in their surgery residency. That excites me!
    • My other area of interest in Gynecology-Oncology, which involves a 3 year residency in OB-Gyn followed by a 3 year fellowship in Gyn-Onc. SIX years to be fully licensed and practicing Gyn-Onc. 
      • BUT I have little to no interest in being an OB-Gyn --- it feels like such a high-risk occupation, with a lot of variables that are out of your control for which you can be held liable. But the babies are so much fun. And the moms are great. And I like to care for women. So I suppose I might actually be a bit up in the air about it...
  • There are so many opportunities to teach. I would love to have the time to teach students/residents as an attending some day.
  • There is time for research as well, if you're into that, which I am.
  • There is a huge flexibility in weekly hours worked once you become an attending. This is really appealing to me, because I know in the future when we start a family, I will likely want to slow down my work and spend time raising our children. 
    • But for the time being I would happily work 80 hours a week in the hospital! Let's just get that straight!
    • And by slow down, I mean work 40-60 hours as opposed to 60-80 hours per week.
  • By going into Internal Medicine, you leave so many options open. There are so many opportunities to specialize, which is very appealing because it allows for time to decide what I want to spend the rest of my life doing without "being stuck" in a less-forgiving pathway like surgery.
  • You know a little bit about everything.
  • You have more time to interact and educate patients (as compared to surgery or obgyn).
What I DIDN'T love about Internal Medicine:
  • The paperwork. Good Lord, the paperwork!!!
  • Sick patients will continue to get sicker; Oftentimes, the best we can hope for is to slow the progression of an illness, which can be frustrating.
    • But sometimes people get better!
    • And sometimes, people will lose weight, quit smoking, eat healthier, and put their health on their priority list, which can mean that some diseases might improve! (ie., diabetes mellitus and hypertension)
  • "Frequent Fliers", which is a rude way of categorizing patients who rotate in and out of the hospital on a very regular basis due to chronic and debilitating illnesses.
  •  Man, oh man, can rounding take ages!! You might walk around the wards of the hospital for 10 hours, nonstop, just watching the attending write notes and visit patients. This isn't so bad if the attending prefers "table rounds", where we talk about the patients while sitting in a room and discussing treatment options and exploring educational topics that arise before trotting around the hospital in a huge group. I find this approach most educational, and my feet and attention span also appreciate it.
  • I would definitely want to specialize. General Internal Medicine is far too broad for me; I want to be the best in one area of medicine.
  • Patient compliance is an issue, which is partly due to poor communication with patients regarding treatment and importance of adherence to medication. 
  • We sit around. A lot. And I'm not one to sit still...
  • I want to work with my hands, at least to a small extent...and I'm not sure how many procedures I would be able to perform as an Internist!
  • You see a lot of really sick people, and you see a lot of death. Which is why it is so important to have personable physicians in this field, for the patient's families' sake as well as for the physician's mental health.


I enjoyed Internal Medicine for its intellectual stimulation and problem solving qualities. There is a lot of patient interaction, which I love. I absolutely loved living the outpatient life. Heme-onc just feels like such a perfect fit. And I could do general internal medicine for a few years without going crazy. The residency doesn't seem too horrible, at least from the hours/week standpoint.

I have no idea what it would be like in England. But if I stayed in the states, I would likely go down this route of Internal Medicine residency (3 years) followed by Hem-Onc residency (2 years) and I would be a very happy woman when all is said and done.

Tuesday, February 21, 2012

Tasty (FAT) Tuesday

Joyeux Mardi Gras, tout le monde! I can't believe it's that time of the year again already...it honestly feels like we've just celebrated new year. Crazy how life continues to fly by despite our desires to slow it down.

I love fat Tuesday. Going to New Orleans to celebrate Mardi Gras is on my to-do list for next year. If we are in the states, we will make it there. Sorry, medical school, but I need my celebrating with parades, beer, and amazingly delicious french/cajun food. I can't even imagine how much fun it would be! So for the time being, Mike & I celebrated with a nice workout sesh followed by an overindulgence in Paczkis (Polish donuts that are traditionally eaten on the Tuesday before Ash Wednesday). No King's Cake in sight, and we didn't even make pancakes in honor of England's tradition for today - affectionately called "Pancake Day". Well, maybe it'll be a night snack - lent begins tomorrow so I need to fatten up as best I can today! ;)  And I LOVE english pancakes - its a mixture of flour, egg, and milk that results in a thin little thing reminiscent of a french crepe. We sprinkle some squeezed lemon juice and sugar on top to finish it off. It's delicious. If I'm dying for chocolate, some Nutella spread over the crepe with some sliced bananas really hit the spot.

Of course I have more to tell you about than just Fat Tuesday traditions! If you remember from last week, we decided to follow a menu for our nightly dinners. It has been phenomenal. I'm back in the kitchen cooking again, which means that I am finally working with my hands (despite being on my psych rotation!).
eMeals - Easy Meals for Busy People!
And, since it's not super-healthy cooking like I sometimes do in the kitchen, Mike actually likes what I make (he always turns down my baked whitefish with grilled asparagus and wild rice). So, here's a little spread of what we've enjoyed in the past week. Apologies for the photo quality, they were only taken from my I-Phone!


BBQ roast with sweet potato; BBQ Tortillas; Fisherman's Stew; Chicken Quesadillas, Beef Stir Fry; Kale & Mushroom Breakfast Bake; Fruit Medley; Cheesy Pull-Apart Bread; and Chicken Pasta Salad.

Monday, February 20, 2012

Psych: Day 10

Today has gotten away from me. Long day at work, went to the gym, put together a presentation about bipolar disorder and genetics that I will be presenting tomorrow, made dinner, read up on some details for tomorrows new patients, washed the dog, did the budget, worked on the guest list, then finished with an episode of mad men (my newest tv obsession). Busy day. I'm ready for a bit of a slow down any time now!


So I've been thinking about Whitney Houston's death recently, apparently from an overdose of depressant drugs. Strange how all the celebrity deaths can be linked to poor medical practice - it is never a good idea to give an addictive drug like Xanax or benzodiazepines to someone who has a history of addiction. Being famous does not make it any safer or more reasonable to give in - giving benzos to a woman with some serious problems with drug addiction is poor medical practice. I hope that this tragedy helps remind us of our primary duty as physicians - first, do no harm. Its so easy to forget this principle when blinded by the celebrity or by treating our friends or families. One would wish this will serve as a reminder to us to practice medicine responsibly, That we might learn from our mistakes so that they don't happen again.

Another little something I got all the way from England - a cute headband. Works so well with my professional attire. :)



Sunday, February 19, 2012

Venue

Whooooooo we decided on a venue today! Our wedding planning has officially begun - only 14 months after our engagement! ;)

We went to a bridal fair at the venue. Our friends were promoting their businesses - one is a professional videographer (he has about a million talents), and our friend Gina was selling her makeup skills as well as Mary Kay makeup products. We have had our eyes on the place for our venue for a while - and we will (fingers crossed) officially book it in the next two weeks. We want to get the church and photographer booked for the same day before we officially set the date. I'm excited! Even mike was excited about wedding planning today! It's gonna be fun to finally put our ideas into action. :)


Saturday, February 18, 2012

With a Little Help From Our Friends

Enjoying a little night out with our friends!

We spent the day working on paperwork and bills, working out at the gym, cooking fishermans stew and cheesy pull-apart bread, watching Greys, tidying the house, getting ready, shopping, dinner, and drinks with friends while listening to our friends perform live music at our favorite American pub.

Weekends go by far too quickly...



Friday, February 17, 2012

Style Saturday

It's a day early, but just consider it "Fashionable Friday" for this week!

Something which I have been thinking about for a while now is how I need to focus on things outside of medicine. I find that I get a little burnt-out when my attention is solely placed on work, study, diagnosis, treatment, prognosis, pathophysiology, and mechanisms of action. So I'm going to work on another area of my life that I enjoy - fashion.

I say fashion, but I suppose it is more like my style...fashion seems such a broad term, and with a very couture connotation...but I'm more into what I find suits me and my career. Around here, it's easy to fall into the trap of wearing exactly the same things as everyone else, especially in the medical profession. Everyone plays it very safe, wearing black or grey pants with very plain tops, as no one wants to stand apart from the others. Usually when I start on a new rotation and need to make good first impressions, I do the same. I'm very conservative on my wardrobe for work, especially when I know that I will be meeting with physicians who I admire to emulate. But I desperately don't want to be boring. I want to dress with some sort of style, with bits of fashion in my outfits. Also, I don't really like to wear pants, I'm a "skirts and dresses" kind of girl. I don't like to wear what everyone else has on, I don't like to just fit-in. It's difficult to do, as a med student, to be confident enough to be a little daring when you are so far down on the hierarchy of physicians. So this, these "Style Saturdays", will serve as an outlet for me, showcasing things I do wear, things I would wear, and things I wish to wear.

A Few Things I'm Loving This Week:


From: H&M, Dorothy Perkins, Next, River Island. AND - Each item is under $50.

1. I am absolutely in need of a pink blazer!
2. I still love the nautical stripes. Add in a bit of fine knit and I'm sold!
3. I am loving the color-block style that's coming back from the sixties! The shoes, that skirt, the pink cardigan - Who could resist that sixties charm!?
4. On the search for a pleated skirt. This dress in teal would do just fine!




Thursday, February 16, 2012

Psych: Day 8, 9

We had a new patient clinic this morning. I evaluated a young lady with a history of bipolar type II and generalized anxiety disorder. She was also in with a significant comorbid medical problem, which has been a cause of some distress. Some things that stuck out to me from the interaction - "my friends would ask me if I was on drugs because I was always so happy, even as a kid"; "I could spend days doing things, I had three jobs and went to school full time and still felt like I could do more"; "I have come to notice that the big things aren't so bad, it's the small things that are big for me." she was interesting. I really liked talking with her. I think her prognosis is good as well, which is a promising sign.


Marley is feeling a little bit better. Her lungs have some rales in her lower left lobe especially, but hopefully she gets better with the meds.

Just enjoying some moscato and a film with my two favorite people! (mike and marley)

Tuesday, February 14, 2012

Psych: Day 7

Happy Valentines Day! Spent the day in clinic for a few hours followed by lots of time with my Mikey. We took Marley to the vet because she's been coughing a lot, and we were given amoxicillin for bronchitis. Reckon she has kennel cough, and the infection has gotten worse. Last night she was having some difficulty breathing. After trying to clear her throat, she still was wheezing a squeezing sound through her throat. Hopefully she'll be back to herself soon. So we bought her a new kind of food (fish and sweet potato blue food), which she loves maybe too much!

So for this tasty Tuesday, Mike and I decided to subscribe to a menu planning service online. It's a groupon right now, and it's through emeals.com. So we printed this weeks menu and then went to the grocery to get what we needed as stated on a printed list. I'm so excited about this! We decided that we wanted to have low fat meals made for two, and even had the lists specified for our favorite grocer and their weekly deals. Pretty useful! I imagine this is going to help us to eat healthy and eat proper portions, it will force us to broaden our dinner meals, it will give us time to improve our cooking skills, reduce our wasted food due to spoiling, and we'll get to spend time in the kitchen and enjoying our meals together. I'm really excited to give it a try! The meals look delicious, healthy without being like a crazy obsessive annoying organic health freak kind of eater. Just a normal, health conscious person deciding to make healthy choices on a daily basis. I'm hoping this will help to jump start our fitness regime as well!

I'll give you a recap of the weeks meals next week! :)

Tonight, we enjoyed a little moscato and Brie pastry bites and spending time together. It is so nice to have Mike home. We spent a little time reminiscing over our previous valentines, and snuggled with our first valentine gift we gave one another - miss Marley! Hope you all enjoyed today with those you love!


Monday, February 13, 2012

Psych: Day 6

Mikes home. Marleys happy. It's a good day :)

Full of new clothes for me! Including this cute Zara jacket. I'm such a happy girl!

Sunday, February 12, 2012

Mike comes home tomorrow, I can't wait!

It's been a long couple of weeks without him. But at least I have my little Marley here to keep me company.


Saturday, February 11, 2012

Disclaimer: Facts have been changed to protect privacy.

A patient that I have seen in the past week came in for a visit because of a referral from a pain clinic wishing for psych to clear her of drug abuse. She had tested positive for opiates before being prescribed any morphine or oxycodone or opiate pain reliever, and she was to be evaluated by the psychiatrist for drug abuse before being able to be prescribed any narcotic pain relief. She had been involved in a very unfortunate trauma; while vacationing, she was running on a bumpy trail which made her back feel sore. The next day, while bending over to pick up something, she heard a squish-snap sound and fell to the floor. From there, she was diagnosed with Cauda Equina Syndrome. Being that her insurance coverage was sub-optimal to say the least, she was told to undergo physical therapy for rehabilitation. In most unfortunate circumstances, she awoke one morning to excruciating pain and the inability to move anything below her umbilicus. Upon quick evaluation in the ER, she was found to have developed spinal entrapment and required emergency surgery to correct it. She had been arguing with insurance companies to allow her to undergo this procedure, but they continually denied it stating that she was too young to sincerely require the surgery...so when she had to have it emergently, there was significant morbidity that came along with it, including most notably her inability to control bowel/bladder (the first sign of spinal cord compression as described in the Oncologic Emergencies blog). Due to this event, the patient has, understandably, been in enormous amounts of pain. In an attempt to self-medicate, the patient got a hold of a narcotic pain reliever and used it without a prescription, it was found to be in her system on a urine tox screen, and she was then sent to psych to evaluate.

She clearly had serious trust issues with doctors, so when we attempted to obtain consent to treat, she was extremely reluctant. We might, in fact, hear something suspicious and then we would be required to report it to the proper authorities. After explaining that our interests are to help her, not harm her, she reluctantly signed the waiver and the interview began.

To say she had a rough life is such an understatement. While a young child, she was abused in every sense of the word. She was not allowed to have friends, she was beaten, she was tortured, she was in the worst situation I can possibly imagine. And when she was old enough to leave, she did. And she tried to make a life for herself, which must have been exceedingly difficult to do on her own, without guidance or money. She opened up to us, she was in so much pain, both emotionally and physically. I have never even imagined a life as terrifying as hers.

Now she has a strong relationship with a partner, who is a great source of support, understanding, and helpfulness. It was beautiful to see that someone in her life loves her, despite the number of people who have hated her who should have been her main support throughout her childhood.

She clearly was in a horrible state. There were so many things going on with her, things that have been present for her entire life, yet she was able to cope with some horrific events. The resiliency of some people absolutely astonish me. It wasn't until she lost her ability to walk that she became clinically depressed. And, considering how terrible her situation was and how unfortunate she was, she was coping better than I would imagine 99% of the world would.

I guess I just wanted to share this story to remind us all that we are all in this life together, and that everyone has their own demons to face. If we can only remember that in each interaction we have with others, the world would be a better place.

So I put together a photo of a few things that made me happy today:



Friday, February 10, 2012

Psych: Day 5

Today, I was on Outpatient and Inpatient Child/Adolescent Psych. Many of the children that I saw today have a diagnosis of ADHD along with mood disorders. I spent some time with a child with oppositional defiant disorder, which can be a pre-cursor to conduct disorder, which precedes anti-social personality disorder. It is interesting how so many different things can play a part in the development of psychological disorders, and how those things can impact a child and skew the normal development of a person at such a young age.

I am so thankful that there are people who can care for patients such as this, who have incredible patience and understanding. Even after spending just a few hours in childhood psych, I felt overwhelmed and a little hopeless. These patients will never have a "cure", and the best they can hope for is a "normal" life, which, to me, is such a depressing situation to handle day after day as these psychiatrists do.




I spent the rest of my day cleaning the apartment because Mike will be home on Monday (and I haven't cleaned since he left...oops). Made myself dinner (an actual meal as well) and did some revision. Another exciting weekend in the life of a med student...


Thursday, February 9, 2012

Psych: Day 4

"There comes a point in everyone's life when they get tired of fighting, and they just want to live their final days on their own terms." - cardiologist attending

I suppose he's right. It's been a tough day. My young cousin elected for hospice care instead of continuing aggressive chemo. And the only way I can explain how I feel is indescribably sad.

Wednesday, February 8, 2012

Psych: Day 2, 3

Third day of Psych. Here's a little of what I've learned so far:

People that are seriously depressed seriously need help to get better. It breaks my heart to hear of some of the things some patients have been through. Some of them come out better for it, some come out ok, while some come out in a horrible shape.

You are a product of what surrounds you. Seriously. From the earliest days as a child with your parents and siblings to school to college to workplace to family, it's important to surround yourself with people that encourage you to become a better person.

Normal to me is not normal to you. If you grew up in an abusive family and then married into an abusive family, it is "normal" for you to be abused. So the necessity of clarity in questions and history taking is evident.

Any trauma to the frontal lobe can cause serious personality changes.

Never underestimate the power of being nice.

Patients open up to you on a whole new level when you work in the psych clinic as opposed to any other health field.

Whatever stereotype you might think is true regarding drug users is completely irrelevant. Drug users come in all shapes and sizes, from the poor and homeless to the rich and educated and everything in between. Never assume just because someone is intelligent and well-dressed that they are above drug abuse.

Resiliency is a trait that is difficult to come by and is highly valuable. Never take for granted your ability to bounce-back from life's setbacks.

No matter how horrible life may seem, there are so many people out there who are struggling with so many worse things.

All people really want is an ear to listen, a shoulder to lean on, and a kind heart to confide in.



Tuesday, February 7, 2012

Tasty Tuesday: Cheesy Hashbrowns Dish

This Tuesday, I made one of my favorite dishes that I grew up eating. On Sundays when I was growing up, we would have brunch together with the whole family and always have a side of "Potato Dish".

Its just a bag of hash browns in a casserole dish. Then you add a cream mixture of melted cream cheese, little bit of butter, onions, can of mushroom soup, and some fresh mushroom pieces on top of the hash browns. Top it all off with a layer of shredded cheddar cheese. Toss it in the oven at 350degrees for 1.5 hours and enjoy!

Mike says that it reminds him of cheese and onion pasties from home.

My first proper (sort of) meal I've made for myself in ages... I'm ready for my chef to return any day now! ;)

On another note - happy birthday daddy!!!

Monday, February 6, 2012

Psych: Day 1

What a long day. So we started psychiatry today, began with orientation. Went to the psych hospital and we were taught defensive arts and how to get out of a hand grip or how to release someone's teeth from your leg if they bite you and to run away when things get a little shady...I'll be working with patients who were committed for murder and things like that who were declared insane and are serving time in a psych hospital. I don't know how excited I am about it. I'm so scared to get hurt, I'm really nervous about this rotation. But first I will start with outpatient - which begins tomorrow at 7.

We had a little orientation to fourth year today. I am so excited, I am really almost in my last year of school! Unbelievable!!

Of course they fed us dinner - none other than pizza...again.

Sunday, February 5, 2012

Anyone catch the united v Chelsea game?! What a match! Love to watch good football, even if I don't support either team. It's just nice to see such talent on the pitch.

Loved the time I spent at home. We celebrated my dad's birthday and watched the super bowl together. I played doctor with my niece, Katelyn, which made my day. It's fun to share my love of medicine even if it's just for play time. And we all got to say hello to Mike on Skype! The kids had fun talking with him on FaceTime on my iPhone. So cute. I love my niece and nephews!!!! :)

Even had time to play the piano - I haven't had a chance to really sit down and play in such a long time. It felt good to run through some of my favorites :)


Saturday, February 4, 2012

At home today! Just enjoying life with my mom and dad tonight. Dinner and a bit of sweet red wine to end a great day. Marley is so happy to be home. She loves it here. It's good to be home again!

Also feels pretty good to not have any work to do for a change! :)))

Sat round the fire:

Friday, February 3, 2012

Internal Medicine: Day 46

Internal Medicine - finished! The shelf exam was actually *easier* than I expected. I guess I just always assume the exams are going to be impossible, but I tend to remember more than I think I know (if that makes sense?). I'm glad that I did a bunch of UWorld questions, I'd definitely recommend that. And Step Up To Medicine was really valuable. I wasn't really surprised by any questions. There were a few questions regarding some post-partum problems (don't they belong on the OB-Gyn shelf?!), which surprised me. Overall, it wasn't too bad though. Best shelf exam yet! (I keep getting higher percentages with each exam I take)

So after I finished the exam, I went to the gym for an hour and a half. I feel totally accomplished today! Now it's time to flip on the tele and watch a movie with a glass of wine and my puppy. Only one thing missing - MIKE! Oh how I miss him...

...Valentine's Day can't come soon enough!!!

Thursday, February 2, 2012

Internal Medicine: Days 44, 45

I am nearly finished with my internal medicine clerkship. Tomorrow is the shelf exam...To prepare for it, I have followed and read articles involving complex patients during my 6-weeks on Inpatient Internal Medicine (3 on general and 3 on cardiology), read Step Up to Medicine in its entirety (and re-read a few sections, especially cardiology and respiratory as they comprise roughly 40% of the questions on this shelf), and I completed over 500 of the nearly 1500 UWorld Internal Medicine questions (and averaged a score well above the mean). I wanted to get through all 1500 questions, but of course that is quite a task and I didn't really budget my time accordingly. I would love to do well in this clerkship, as I am fairly certain this is what I will do for residency if I intend to become an oncologist.

I'll be sure to let you know how the exam goes tomorrow!


Wednesday, February 1, 2012

Heart Healthy February

Happy First of February! 

Let's be honest - how many New Year's Resolutions have you kept? I'm doing well...except the whole "45minutes of exercise 4 times a week" and a dog walk everyday. It's been difficult, working 60hour weeks and studying when I do finally get in. Just can't really squeeze in a nice long run. But I am dead set on fixing this while I'm on psych/neuro. It will happen. In the meantime, I've kept some dumbbells by my desk to at least do some arm training, and I always take the stairs (and there are a lot of stairs in the hospital)! And about the dog walks - Marley is just too tired from doggy daycare to be interested when it's sunny - and when it's freezing out or raining, forget about it. Marley refuses to set foot out the house when it rains! ;)  But the whole eat healthier resolution has definitely stuck.


And what better time to eat well than February - it is, after all, Heart Health Month! Healthy eating on its own can drop your blood pressure by at least 6 points (even more if you are already on the higher pressures).  Add in exercise and the decrease is even more dramatic.  In fact, when a person is found to have blood pressures in the 120-139/80-89 range (so-called "Pre-Hypertension"), we opt for lifestyle modifications before we choose medications! That's how important healthy habits are for your cardiovascular system. The Mayo Clinic has released a few tips on how to improve your heart health by making healthy choices in your diet. They include:

   1.  Limit saturated fats and cholesterol.
Avoid trans-fats at all costs! (Companies are sneaky about this, and don't always state on the nutrition label that the product contains trans fat - but any ingredient list that says "partially hydrogenated" or "hydrogenated" means it contains trans fat - don't buy it!)
Try and use fats that are liquid at room temperature - like oil, which is high in monounsaturated fat - rather than solid at room temperature - like butter or margarine, which is high in saturated fat. Polyunsaturated fats found in nuts and seeds are also heart-healthy fats.


   2.  Choose low-fat proteins.
Lean cuts of meat, chicken, turkey, fish, egg whites, and low-fat dairy products are all good choices of low-fat protein. Other good protein-rich foods include legumes (like beans, peas, and lentils), soybeans and soy products (tofu).


   3.  Eat more vegetables and fruits.
High in vitamins, minerals, and fiber, low in calories. The fiber helps to trap fat in the GI system, which prevents them from ever being absorbed into the bloodstream. An easy way to promote healthy snacking - clean the veggies and fruits after you get in from the grocery, cut them up, and make them easily accessible in the fridge, so its a handy and quick go-to snack.


   4. Select whole grains.
It's easy to replace the foods you normally buy - like pasta and bread - with whole grain without noticing a difference in taste. And you'll be doing your heart a huge favor. The extra fiber in the whole grains help keep fat from being absorbed, and it helps your GI system function more normally as well (and can help to prevent diverticuli and colon cancer). Adding flaxseed to food adds fiber without changing the flavor of food. Add ground flaxseed to your oatmeal, applesauce, or even yogurt for some extra fiber without compromising taste!


   5. Reduce the sodium in your food.
This is a hard one for most of us. The USDA recommends less than 2300mg per day (less than a teaspoon). If you purchase pre-packaged foods, you'll be well above this limit after just one meal. So just be mindful. This recommendation is particularly useful if you are an African American, as the mechanism for hypertension involves salt in many people of African descent.


   6. Control your portion size.
A few portion size pearls to keep in mind:
          1 serving of pasta is 1/2 a cup, which is about the size of a hockey puck.
          1 serving of meat is 3-4 oz, which is about the size and thickness of a deck of cards.
          1 serving of mashed potato is 1/2 a cup, which is about the size of half an apple.
          1 serving of ice cream is 1/2 a cup, which is about the size of a tennis ball.


   7. Plan Ahead.
Create daily menus before you get hungry so you can more easily fight the urge to eat something fast and unhealthy! Add in variety so you're more likely to stick to the healthy eating plan.


    8. Allow yourself an occasional treat.
A few indulgences every now and then won't derail your heart-healthy diet or ruin your healthy-eating plan. Just don't let it turn into an excuse to give up on healthy eating! Allow yourself treats or you'll never stick to any diet. But the key here is balance - what is most important is that you eat healthy foods most of the time!

Reference:
http://www.mayoclinic.com/health/heart-healthy-diet/NU00196








Today was spent in the hospital, followed by giving a case presentation (my patient that I presented had Atrial fibrillation), and finished with an afternoon and evening of studying and completing question banks. Marley has snuggled on my lap all day while I study - I love when she's super snugly! :)