🙂 Hi readers!

Very excited to report that I got good news about CK on Wednesday. I had fully prepared myself to see the glaring word FAIL written in the gray box on my score pdf (no, I didn’t think I would fail but there’s always that doubt in the back of your mind) but I scrolled down, saw PASS, blinked, refreshed the page and still PASS came up again, so that was proof enough for me. Almost everyone I know has had trouble with a test in the recent past–comp, step 1, shelf exams, cs–so it has made me extra nervous. I was worried that I would go down from my Step 1 score, but I did not! Which is great!

So now that that’s done, I’ve applied to programs and am waiting for news. Which brings me to an important topic: Clinicals are EXPENSIVE. Holy cow, take a look:

ECFMG certification (so you can take Step 1): $50
IMG Step 1 cost: $790
IMG Step 2 CK cost: $820
IMG Step 2 CS cost: $1440
ERAS token fee (so you can send out residency program apps): $100
NRMP fee (so you can enter in the match): $60 (+ $50 late fee if after November)
Application fees: $638 (and that’s apparently conservative–some spend as much as $7k)

Plus tuiton, fees, housing, transportation, food.

I bring this up because it seems like over the past 3 months I’ve been shelling out more money for school than I ever dreamed of. I got my check back from the school for Semester 9 of 10–they send me back what I have to live on for the semester after they take out tuition and fees, and the check has dwindled down to $1005.00. Are you kidding? They expect us to live an entire semester, paying the fees I mentioned for exams and applications and traveling to interviews on $1000? The problem is that they keep raising tuition–understandable–but they will not increase the amount of money we are allowed to request of the private bank who fulfills our loans, so we get less and less back each semester. We’re forbidden from getting jobs so what are you to do? In my case, lean very heavily on my folks. I think other classmates are having to take MBA classes on-line to get more loan money from that just to be able to make it. Not good. If you’re not Canandian (with large province loans), your parents aren’t doctors, you don’t have a rich uncle, or a hefty savings account from a previous career, you’re running out of luck at MUA.

Hiatus

September 18, 2013

Aloha, Readers!

I’ve missed you guys! Thanks for the great questions–they’re really helpful and I don’t mind answering them at all! They bring up really good points that I don’t always discuss on here.

So to catch you all up, I’ve taken my CK–waiting on scores. I’ve booked 4 of my 6 electives and am just waiting on confirmation on my last 2. Once I get my CK scores, I will send off my 2014 residency match apps! And I’m finishing up my last core, Peds, this week and will take the NBME for that on this upcoming Saturday. Whew. But before that, I have a lot going on during this last week in neonatology–just finished a presentation on birth trauma and perinatal asphyxia–and don’t have time to sit down and write a proper post just yet. Still, I wanted to check in, say hi, and wish you all luck with your applications/basic sciences/clinical sciences/ERAS apps.

Elective Suggestions

August 7, 2013

Good Morning, Readers!

Still on my study break, so won’t get off on too big of a tangent but wanted to write something to those of you who are just beginning clinicals.

So the school tells you, starting during your Med 5 clinicals meeting, that you will be responsible for setting up all your own elective rotations. At first that sounds really intimidating, but then you’re told that it’s not that complicated and not that big of a deal and not to worry so much about it. You calm down, go on with your core rotations and sort of put it in the back of your mind. DON’T!

I had read, during my exhaustive research on valuemd before choosing a school, that it’s vitally important to try and get ALL of your cores done ASAP, and with as few gaps as possible. As with many other topics on valuemd I thought these were just students being fastidious and took it with a grain of salt. I just HAPPENED to LUCK into getting all of my cores booked back-to-back in Chicago and was elated about not having to move for a whole year, but had no idea how truly lucky I was! Here it is fourth year and everyone is trying to set up elective rotations and I have SO MANY CLASSMATES who are lacking just one of the 6-week cores…and they CAN’T GET ELECTIVES! It’s terrifying! Now that’s not to say they can’t get ANY rotations, they have gotten some, but I have now talked this over with multiple classmates who are all having the same trouble. They’re scrambling to find a site to finish their last core before they can book more electives.

You’d think, for example, that if you’re trying to do a rotation in say…peds allergies and asthma, that just because you haven’t done your psych rotation yet, you’d be ok. I mean, you’ve covered the biggies: peds, IM and surgery. WRONG! I have no idea what psych has to do with peds allergy and asthma. And it’s not about the number of weeks you’ve completed either. Almost all of these folks who are running into trouble have completed a family medicine elective (also 6 weeks long like their missing core) but the rotation directors still won’t take that in lieu of the last core.

So my advice to you folks, get your CORES DONE!

I’ll discuss more about electives later but for now, I’m taking an ACLS class today!

Ahoy, Readers!

July 16, 2013

Hi guys,

Hope the summer’s treating you all well. I’m in the middle of my study break for CK, grinding away. It’s actually not as bad as studying for Step 1; I think I like the Step 2 material better because you can logic your way through most questions–ex. well duh, you’re not going to do an X-ray or CT scan on a pregnant woman, that’s two answers gone already when trying to figure out the next best test. I got a visiting student study pass at the University of Chicago medical library (FREE!) for the summer, so I’ve been bussing there to get some peace and quiet and a solid study environment. Studying at home is ok too, there’s just a lot of distractions like Candy Crush Saga, cooking, running, etc. I’ve found UWorld and Kaplan questions to be most helpful so far. I realized I’m not utilizing the radiology photos given to us in questions to my full advantage, so I’m reading First Aid for Radiology for some tips on interpreting what I see. In general, I’m finding it more difficult to sit down and read review texts than questions, so I try and focus on the questions.

OB finished nicely. As I mentioned, was grateful for the outpatient clinic afternoon. Didn’t think the shelf was particularly difficult–finished with almost an hour to spare which is UNHEARD of for me, a fast test-taker. Scores haven’t been posted yet, though, so I have no idea how well I did on it. Went back to visit OB attending and she was happy to see me.

The second 5k went well–it was the Chicago Women’s Half Marathon and 5k. Have completed a third 5k since then, the Bastille Day 5k, and my times just keep getting better. Have the Color Me Rad 5k on Saturday, then the Biggest Loser 5k in August. There’s a Firefly run in the afternoon sometime soon that I was thinking about doing, but we’ll have to see. When running outside during daylight hours, you have to be really careful about how hydrated you stay. I got really overheated the other day during a 10k run and ended up walking the last 3k home because I hadn’t properly hydrated and was starting to feel the early symptoms of heat exhaustion. I should probably run with water, yes. I had sort of slacked off on my diet, utilizing some great deals groupon has had on fantastic Chicago haunts, with the rationale that I was allowed a pre-race splurge. But then saw the photos from my last two races and was disgusted. Back on the diet. Have been doing low-carb, still vegetarian. Life without carbs makes it more difficult to run so to compensate, I’m cutting back on my distances, doing more 5k’s with an occasional 8k, cutting myself some slack if my times aren’t record-breaking. I’ve noticed there’s a lot of broken glass strewn about where I usually run (this includes by a CHILDREN’S HOSPITAL!), so to all of you readers out there walking/running places, be careful!

Went out with some friends to Six Flags Great America and had a blast. It’s been years since I went to an amusement park and I have to say that the rides have gotten a lot cooler from what I remember. I rode the Superman coaster where you sit down, then the ride flips forward so that you complete the ride on your belly–like Superman flies. AAH! So cool! Was worried that with my hips I wouldn’t fit on some of the rides; didn’t have a problem all day. Whew. Really enjoyed the waterpark too. Wore board shorts and a rashguard over my bathing suit and felt less self-conscious.

Booked tickets to fly home next week to drive my car back up to Chicago so that I’ll have a way to get my peds rotation, North of the city. I don’t really intend on spending much time there as I need to get back and study for CK, but I have promised a friend, also from NC, that I would bring her back some of our sacred BBQ. I’ll gladly take a day off of my diet (who really sticks to their diet when they’re visiting home, anyway?) and make the pilgrimage down to Shelby, NC to Alston Bridge’s to pick up high quality BBQ for her and some of my favorite BBQ sides for myself–fried okra, hush puppies (and BBQ sauce to dip them in), red slaw, YUM!

Can’t believe I’ve been gone from the island for over a year now. Good luck to all those kiddos finishing up now, getting ready to take their Step 1’s. While parts of clinicals have been frustrating, overall, I’d say I’ve really loved the experiences. I’d take hands-on learning with patients any day over sitting in a classroom learning from powerpoints. I’m getting further and further removed from island culture, but please keep bringing the questions about island life and basic sciences–they’re great questions!

Ok, will probably be in touch after CK is over. Have a great summer, guys!

Intra-OB Update

June 20, 2013

Helloooo Readers,

Time for another update. Since we last spoke, I’ve gotten further along into the OB curriculum. Turns out we didn’t have all 12 students in our rotation; some were doing electives and some stopped showing up, for whatever reason, so there ended up being 9 of us who showed up on a regular basis. Our Doc ended up cancelling quite a few lectures because of CME stuff and being on-call for medicine and OB services, so in order to compensate, we doubled the number of presentations. I had intended to update the blog earlier, but in trying to keep my study schedule and do 2-3 presentations weekly, it just kept getting pushed to the bottom of the to-do list.

Similarly to my experience in Internal Medicine, my attending has left for a long vacation abroad and I have been left with vague instructions as to what to do in her absence. We were told that one of the other docs had agreed to let us observe during his clinic hours (which was a blessing since the residents did all of the pelvic exams while we were in lecture) so I got the chance to see how outpatient visits work out. For once, I’m actually grateful for the required homework the school makes us complete weekly during our core rotations. The first patient encounter I got to observe involved post-menopausal bleeding and an endometrial biopsy. Thanks to a similar homework case from a couple of weeks ago, I knew ALL STEPS involved in the procedure, in addition to having recently reviewed the risk-factors for endometrial ca (which I was grilled on.) 🙂 Also, I had just completed a presentation for lecture the week before on methods of contraception, which included a lengthy section on IUDs. Low and behold, the next patient encounter I got to observe was the replacement of an IUD! So yet again, when I was grilled on the nitty gritty of IUDs–side effects, mechanism of action, duration, type, indications, etc., it was all familiar. This is the first rotation where I’ve really gotten to apply my knowledge like that DURING the rotation, rather than just on the shelf exam. Perhaps because comparatively, surgery and IM are so broad that it’s much less likely that you’ll be studying the same thing that you encounter in clinicals, in the same general period of time. Or in my case, remember all those details associated with the topic when you need them, on the spot.

So, let’s see…outside of clinicals what’s been going on? Well, still having quite a time setting up these electives. This new VSA (visiting student application) that the major teaching hospitals are using is really edging out the spots available for Caribbean students–you have to be at an LCME school in order to use it. Many places that previously accepted Caribbean kids have started stating that if we can’t submit a VSA, they’re not interested in taking us. The folks in the school’s clinicals department have a lovely, plush list of hospitals that have taken kids for electives before, however if you take the time to go through the list, most of the places no longer accept us. I’m not quite sure that the clinicals department knows this yet–with each of my communications with them, they seem to be puzzled as to why I don’t have more of a solid clinical schedule set up yet. Please–it’s not because I’m lazy! I’m trying, really I am!

Alongside the search and paperwork, the school has started requiring the submission of 3 somewhat-lengthy documents before they will approve students to sign up for the Step 2 CK. I was under the impression that this would not apply to students trying to actually sign up for the CK NOW in the current testing block that is ticking away, but I was mistaken. I painfully clicked submit, coughing up the $820 for my CK registration, then, rather than a scheduling permit, got an email from the school a couple of days later wanting to know where my planning documents were before they would approve me. “Aw mannnnnnnnnn” was my reaction. Every day that these documents were incomplete was another day the school would not approve my request, and another day that the available testing spots (for the 9-hour test) through the end of this testing block (through August 31) were being reserved by other students. I rushed home to complete the documents, tedious as it was. They want to know what subjects you’re studying, when you’re studying them, for how long, how many practice questions you’re completing, and what sources you’re using. Ack. Oh–and they want to know what distractions you have as well–like if you’re currently completing rotations or days that you’re taking off from studying for travel, shelf exams, etc. Everything except your bathroom schedule.

And that’s just the first of the documents; there is also another document wanting to know your elective plans. Finally the third, and unfortunately MANDATORY [as it would seem] document is a leave-of-absence request. Leave of what? But I’m not going to be absent…Generally speaking, if you’re going to have more than a 3-week gap between rotations, you must fill out the form and let the office know what you’re doing and why you’re not in a rotation. My core rotations were scheduled back-to-back and I was NOT planning on taking a break before CK as I’ve had ample down-time to study during my surgery rotation (and you’re required to explain breaks on your residency application). Not acceptable. I’ve been instructed to take a 6-week break between OB and Peds to have unencumbered time to study-for then take the CK, thus my peds rotation is being rescheduled. Crap, that means no peds rotation before the CK–I’m going to have to teach myself the pertinent peds info. Immunization schedule here I come! There is a silver lining–in the rescheduled peds rotation, I get to be off-site with the “really awesome” pediatrician, rather than the chain-smoking, frequently-cancelling grump (how can you be a pediatrician and grumpy–right?) on-site, however this puts me 6 weeks further behind and 6 weeks closer to not making the April graduation. Ugh. Yeah, I’m trying to be positive but I kinda feel like my wings have been clipped.

Meanwhile I’ve been scrambling to make arrangements to have my lease extended (to accommodate the extra time here that the rescheduled peds rotation is going to take), and to have my folks either fly me home or drive the car up here themselves so that I’ll have a way to get out to the ‘burbs to the peds rotation, eventually. I heard from other students somewhere that in morning traffic, it can take an hour and a half to get to the rotation by car. I shudder to think what that would take via public transportation. So as much as I’ve tried to make it in Chicago without a car, looks like I’ll have to have it for the last rotation. Oh well, will make moving easier. (Just googlemaps’d it–the office is not reachable without a car. It’s a 2-hour trip via public transportation and you still need a taxi to make it to the office. Yup, car is definitely necessary.)

On a happier, less stressful note, I completed my first 5k in the US. When I did the Nevis 5k, I couldn’t jog for more than a minute and ended up walking most of it, with an abysmal time that was just under an hour. My couch-to-5k program (which I graduated from!) has gotten me jogging respectable durations so that I was able to run for the majority of the race and came in at a time just under 45 minutes. Not bad for someone nearly 100 pounds overweight! Of course, since then my goal has been to keep going–to get the time lower and lower, so I’ve started a 10k training program which keeps me running the same 3 days per week [as the c25k program], but is increasing my distance and *hopefully* making my stride more efficient. In addition to the Color Me Rad run I have scheduled in July, I have a 5k this weekend. I’m excited. Running alongside other folks is so much different than just jogging along the lakefront trail with my music and the training program to push me. It’s much more intimidating, but in a good way–my race time was my personal best–so I guess the competition is good for me.

Hello, Readers! How ya’ll doin’?

Have been up to my elbows in paperwork–much to do before September–asking for more LORs, investigating electives, completing forms for the school, trying to get signed up for my Step 2’s, emailing folks with “connections.” I never knew medicine was so political. The paper-pushing’s tedious at times, but not that difficult. Just keeps me from doing fun things, like blogging. :/

So, when we last chatted I was being grouchy about not getting my grades on time. Well, you’ll never guess what happened. I got a call from the coordinator at the hospital who told me she was doing an audit of my file and noticed there was NO EVALUATION from my psychiatry rotation in NOVEMBER and she wanted to confirm that I did it. HA! That’s why I have no grade–the school has no eval! I confirmed that I did, indeed, do my rotation and offered to come in and bring an eval to my doc. The coordinator said she’d take care of it. I heaved a big sigh of relief when I hung up the phone. That’s one mystery solved. In the mean time, my grade for IM was updated so that I have my shelf grade AND final grade, meaning all 3 of my evaluations made it back! YAY!

I had a snooty, condescending blog comment from a resident enlightening me that clinical grades don’t matter to residency programs when you’re an IMG because, according to them, residencies know we have crappy rotations at crappy hospitals. That’s not the point. The school is required to send my transcript off with my application and I do not want a giant INCOMPLETE on my transcript because of something I could have fixed months ago. Yeah they might not care about A vs. B vs. High pass, but incomplete is different. That prompts statements like “Oh you’re applying to psychiatry but it doesn’t even look like you’ve completed your psychiatry core!”

Surgery is over. Ended up going home for a few days during the 11th week to play caretaker when both my parents caught the flu, then my dad, a smoker with close to a 50 pack year history, came down with pneumonia. I reminded Mom that the flu shot could have potentially prevented this…she begged to differ and still politely refuses to get a flu-shot. ::sigh:: Came back to Chicago just in time to unpack, catch the last lecture the next day, get a good night’s sleep and take the surgery shelf. It wasn’t nearly as bad as everyone says it is. Because there aren’t that many surgery questions available in the major q-banks, I followed advice I had heard from upper meds and went back and started doing IM questions when I ran out of surgery q’s. Admittedly, there did seem to be a lot of mostly-medical questions, so I would say it was solid advice. I had a pretty strict study schedule for the first half of the rotation that involved quite a bit of reading and at least 50 practice questions daily–I think this had something to do with how not-so-intimidating the shelf felt. I have many classmates who, per usual, have waited until the last minute to take the shelf (now that their new rotations have already started) who are nervous and freaking out about it. It’s hard to be objective about how prepared you are when you have taught yourself most of the information. Oh well, they’ll be ok.

Had the first day of OB today. Liked it–was impressed with the doc. A lot of what she talked about was information I had already covered in the 100-or-so practice questions I had done on OB stuff in a fit of boredom this weekend. Tricky stuff that is high-yield for exams. Cool! A TEACHER who wants us to do well on our exams! The doc remembered me from IM–she had lectured some mornings at morning report–and made eye contact with me several times during her talk today. We have 12 core students in our rotation, a bit too many for the intimate 6-person table in our meeting room so I ended up squatting on the floor during the lecture. Also we have 5 or 6 5th semester students spending a week shadowing the doctor, so you can imagine how crowded it was. We were handed a list of 42 topics and told to have presentations ready on 2 of them for each day. With 12 people, that’s not too daunting. I volunteered to have a presentation ready for Wednesday since many of the others will be missing class to go take their shelf exams for their previous rotations. The kids who completed surgery with one of the other doctors are required to turn in a giant packet of 23-or-so essays they’ve had to write on interview techniques throughout the rotation. Many of them are still finishing it up and have to turn it in this week, so they’re temporarily out of the presentation line-up as well.

I’m up to week 5 of my couch-to-5k program. They used to measure the amount of time I’m supposed to run in seconds, then minutes, now they’re measuring it in miles! AAH! Fat folks don’t run! Apparently this one does! I’m trying to take it one day at a time and pace myself and stretch really thoroughly. I’m a couple days behind (you’re only supposed to run 3 days a week) but I don’t want to run for 5 days straight this week and risk an injury so I might just have to be behind for a bit. I’ve gotten winded, but have not had an episode yet (knocks on wood) where I wasn’t able to complete the workout as instructed. Listening to music with a good beat helps, as does running outside so that you have surroundings to distract you. I set silly little goals for myself like running to the next mailbox or running through the end of the song and they seem to be what keeps me from quitting when I look down and realize I have more time left than I do running-stamina. (Forcing myself not to look down at the timer, also, helps.) Oh, and a little bit of sugar-free RedBull before the run never hurt either. Heh. I’ve signed up for the Color Me Rad 5k in July, so I have a goal to be responsible for. It’s good motivation when you feel like sitting on the couch or tired of doing practice questions.

Please keep sending questions–very good questions! Good luck to those of you applying/starting school! You can do this!

Mid-Surgery Update

April 18, 2013

Hello, Readers!

Nice to talk to you again, have missed you. Unfortunately I’m updating from my couch–home sick today with a cold, but it couldn’t have happened on a better day. The wintery snow of Chicago is gone but has been replaced with cold, unrelenting rain and as of late, thunder and lightening. Yes, glad to be inside today.

I’ve held off on writing because I haven’t had a lot of positive things to say. I try to present my view of the happenings of medical school as an IMG, both the good and the bad. Lately I’ve been very frustrated and don’t want to come off as a ‘Negative Nancy.’ Don’t get me wrong–rotation’s going fine. Absolutely love the Doc I’m with for surgery–but it’s the other stuff, the administrational stuff that I usually write about that’s got me down.

So my first core rotation was psychiatry last fall. Fell in love with it. Thinking of going into it. Big deal. Finished at the end of NOVEMBER of last year. I still have no grade for this course. I know, 4.5 MONTHS. Ridiculous. I’ve asked TWICE about this and have been told to be patient, the grades were still being processed. Do you think if I was 4.5 months late on my tuition that I could tell the school to be patient? (A rhetorical question.) I got my shelf score back within 3 weeks (this accounts for 40% of final grade), and I completed all my homework on time (10%) as well as my patient logs (10%), but the missing 40% of my grade is from my Attending’s evaluation of me. If, for some reason, the school hadn’t received my eval, that’s fine. Accidents happen. But it would have been nice to know sooner rather than later (like Decemberish) so I could go back before my attending had 120 more students and got him to fill out another eval. But I’m told to be patient, that surely they must have it somewhere. Argh. I’m doing my best, but 4.5 months is really starting to stretch my patience.

In addition to my angst over my psych grade, I JUST NOW received my IM shelf grade. IM ended in FEBRUARY! The school gets the grades within days of test completion. What could possibly take 6 weeks? I know, I’m sounding like a Diva, but what “getting my grade” entails is the school posting a link to a pdf of the NBME-generated document that they receive with my score report on it. That’s it. No manipulation needed. It takes 6 weeks to scan 2 pieces of paper? Really? REALLY?

Ok, negativity over. Just needed to get that off my chest.

So, still happy about the strenuousness of IM being over–did great on the shelf. Loving surgery. Makes me wish I was competitive for orthopedic surgery but alas I’m not a strapping, built 20-something male US-medical student with a 275 on my Step I. Got to assist on lots of general surgeries–LOVE the whole fascinating ritualistic process of “changing into OR attire,” scrubbing in, retracting, suturing, stapling, and then being grilled on the spot. Very exhilarating. Time stands still. Looked up the other day and realized I had been standing there retracting for 3 hours–felt like 20 minutes–but how could you not get hypnotized when you’re standing right next to the surgeon and have a bird’s eye view of everything he sees and every move he makes. Got home late one evening and noticed when I stood up that I felt a bit light-headed. Thought about it for a minute and realized I’d had nothing to eat or drink the entire day. Just back-to-back procedures. It was magical. As you would imagine, it takes something pretty interesting to keep the dieting fat kid from noticing she’s hungry.

Have gained a new respect for surgical techs. Because the Doc I work with has been practicing for decades, we get to hear a detailed history on the evolution of most things we do in the OR. Apparently, the old-school surgeons did not like talking in the OR. Doc was telling us that when he first started, he had to signal using hand-signs to his scrub tech, which instruments he wanted during a procedure; that scrub techs and surgeons became so intimately intertwined that surgeons would travel from hospital to hospital with their own personal scrub tech because no one else knew them so well. Doc’s scrub tech is always a step ahead of him–knows when he’ll need a clamp or retraction without Doc even asking for it. It’s amazing to watch.

So yeah, kind of in love with surgery. 6 weeks left.

Received an email that I should be preparing my documents for the 2014 match application. Eep. That time already? There is much to be done–CV-updating, LOR collection, personal statement drafting and revision. Have started shopping around for residency programs and electives. Had my heart broken with the discovery that a couple of the locations in North Carolina that I was looking forward to spending some time at have STOPPED accepting IMGs for electives! NOOOOOOOOO! It’s true. Even though I want to practice in Appalachia, I’m going to have to travel to the other side of the US to complete my electives. It’s such a shame.

Alright, will try to be in touch before the end of surgery and NOT on a sick day. OB is next, followed by peds. Yippee!

Bye, IM!

March 1, 2013

First week of surgery is over. Finished IM a week ago but finally took the shelf exam today. Glad to have a slower pace–IM was grueling, but fun. Sooo much clinical learning. I discussed the gap in knowledge before–that I was worried about how I would get from the book knowledge of basic sciences to actually treating patients–and I’m finally learning that stuff. What IV’s to use, when to test vs. when to treat. It’s fascinating and very exciting.

Thrilled about surgery and very enthusiastic. Meetings have been cancelled this week due to weather–more snow–but can’t wait to see what next week brings.

Missed writing. Will try to be more industrious now that I have a lighter rotation and a bit more time.

February 10, 2013

Hullo, Friends,

No, I haven’t forgotten about you. Still in the throws of internal medicine. Not a lot to talk about that’s not confidential. Had a meeting with the Dean the other week–apparently we’ve applied for US loans and for California approval. That’s cool. Still have 2 more weeks of IM left but then another week until I take my shelf exam. Nervous? Totally. That’s a lot of information to know. I’ve been reading Step Up To Medicine, Master the Boards, and doing a crap-ton of practice questions. Not to mention we’ve had to study Case Files in Internal Medicine for our midterm and final for this rotation. Trying to get back into going to the gym. Feel like a fat cow in tight pants. Haven’t gained that much weight but just want to feel better.

Catch up with you guys later!

Happy New Year!

January 3, 2013

Season’s Greetings, Readers!

Finally have made time to catch up!  Let’s see…

After a successful year without red meat (that was my new year’s resolution last year), I have decided to take the next step and give up meat all-together.  My new year’s resolution this year is to be vegetarian.  I’m excited.  I was looking at my diet over the past month and realized I really don’t eat as much chicken/turkey as I thought and it probably wouldn’t be too difficult to give it up.  Also it makes it more difficult to cheat on my diet–that’s good, right?  The liver’s supposed to have 3 years store of B-12, so I’m not too worried about that–don’t think I’ll keep this up for 3 years, but who knows. 

IM is going swimmingly.  I just finished up the first 4 weeks with my first attending (which was slightly less than “fun”) and am due to start rounding with my new attending when he comes back from vacation on the 9th.  This is definitely the busiest rotation I’ve had so far–there is much to do between being on-call (long call and short call), getting stuff signed off (you know, like that you know how IV’s work and understand echocardiograms), going to classes, going to meetings, doing presentations, reading case files, and ROUNDS, oh my, rounds are a different and threatening beast.  Picture it, you have an undetermined amount of time to go learn everything you possibly can about 2 or 3 patients during which time the doctor can walk in at any time and say, let’s start!  Then he has full authority to ask you anything and everything about your patients and if you don’t know, everyone stares at you and the attending becomes impatient while you have to look things up.  Ya, it’s a little daunting.  I’ve learned so much but I feel like I’ve developed a few gastric ulcers in the process.  Oh–and then too is the fact that most days begin at 4:15 or 5:00 in the morning for me.  So um yeah, that’s why I haven’t been so bloggy lately.  Don’t get me wrong, I LOVE the hustle and bustle…though IM is definitely not for me…but most days just don’t leave me with the energy or the morale to write somewhat objectively.

Had an eye-opening realiziation today.  In working my way up through the ranks in hospitals (first volunteer, then dietary, then secretary, then nursing assistant) there was always this theme of doctors being the be-all and end-all when it came to discussions with patients and their families.  The nurses I worked with were often called into managers offices and chastized for giving too much information to families and strongly advised ALWAYS to default to doctors when patients families had questions with any kind of complexity.  From that end of the totem pole, it was intimidating.  I wondered what kind of life-changing things physicians could possibly have to say to family members that nurses and other personnel would screw up so badly that they were only allowed to utter “You’ll have to ask the doctor about that.”  I hadn’t thought about this in years, but then today when I was looking at the schedule to see what was the topic during our daily afternoon meeting, Inoticed we were supposed to sit-in on the ethics committee.  It turns out this entire meeting was filled with awkward situations where it was defaulted to the physician to make the final call and talk to the family.  My aha moment was when I figured out that THIS was the training for those conversations and, due to the delicate nature of the things being discussed and the ultimate liability of the physician, that’s what the restriction (ask the doctor) was for.  The interesting revelation is that there is no black or white right or wrong–most of this presentation was a discussion of what individuals would have done in each of these situations.  Some would have intubated, some would have started comfort care, some would have waited for a DNI…many different options, but true, ones that do fall on the physicians’ shoulders to decide.  That said, another thing I frequently noticed was that the admitting residents on these cases were frequently uninformed about the patient’s family’s wishes and the motivations for their decisions.  While I understand now why doctors do the majority of the talking with family members, I am a bit disappointed that there’s not more of a collaborative approach to involve the other disciplines.  There is much to be leanred from the nursing staff who spent significantly more time with the family members, and it’s a shame that they’re not more frequently consulted on the family’s attitude, reactions, wishes, questions.  I think it’s a missed opportunity.