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!!!

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...

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?!?