Happy New Years Eve!!

In a few hours from now, it will be 2010, and another year in med school will be done. It's almost hard to believe that this time next year, I'll have already applied for the match, hopefully be in the middle of interviews, and be close to graduating! This time last year, I was getting ready to head back for my final semester in SXM. Since that time, I've finished basic sciences, taken (and passed) step I, completed two core rotations, and I'm currently a month through my third. I guess that things are moving right along and honestly, going pretty well!

So, I wish everyone a very happy New Year. To my friends who are still on the island, about to finish up...only one semester left, and it goes by fast! I know that the island is very difficult to enjoy while you're still there, but try to at least enjoy the weather...you'll miss a little of it when you're gone. To those in clinicals with me...have a great New Year in the states, not having to worry about going back to SXM in a couple days!! It's good to be back.

True odds of airborne terror

Via Gizmodo

How it happened...

finally get to be comfortable

Each day, my IM rotation is enforcing the fact that it never hurts to ask. Today, I asked if we could wear scrubs over the holiday. I mean, they're making us work the holiday, so isn't it the least they can do? Fortunately (and surprisingly), they said it was fine. So, tomorrow I will be wearing pajamas to work...or at least it'll feel that way. Can't wait until surgery when I get to wear them every day! A shirt and tie looks nice, but it's just a pain to get dressed in it every day, so early in the morning!

In other news

Aside from my current disdain for Obama and the democrats, today was a pretty good day. We switched services today, and I'm now in the CCU (coronary care unit). For those not in the medical field, it's an intensive care unit for people with heart problems. The hours are better, there is far less running around the hospital involved, there are less people to deal with, there is no call, and there is good teaching. So, all around, I think I'll like this rotation much better than the other units. Unfortunately, I'm on this unit during christmas break, which means I spend half the time here. I would have rather been on the floor for the break, so I'd only have to be there for one week. But, I guess I'll have to take what I can get. The last two weeks, no one is rotating in the CCU, so I'll see if I can get myself back there again, since I didn't get as much time there the first time around! By the end of the rotation, I have a feeling I'll be more than ready to be done, so it might be a nice way to end things.

I also got to see a cardiac cath and bronchoscopy today. The doctors doing both procedures were very friendly and both tried to teach me as much as possible about the procedures. I've seen a cardiac cath before, but only from behind the lead glass. It was much better to actually be in the room, with the doctor telling me everything he was doing. He was way to fast for me to catch everything and remember everything he said, but at least I understood what was going on this time. Funny though...as with every other specialty I've seen, someone has commented that I won't want to go into that field anymore once Obama is done screwing with reimbursements. I've been hearing an awful lot of negative lately about this health care plan and really no positives from anyone. Maybe that's because MOST americans are opposed to the healthcare bill and only 25% of Americans approve of the job congress is doing? Maybe the congress people should pay attention!?

Dear Obama...

you're an idiot!

Obama is not qualified to run a restaurant, more or less a country. You can disagree with me if you want, but you will see soon enough. It may take a few years, but if you think that US healthcare is bad now...you haven't seen anything yet.

Think it's a good idea that health insurance companies can't turn people down for health insurance anymore? Well, they may not turn them down, but they will make it so that it's unaffordable. Think it's good that the insurance companies are going to be taxed out the ass on "premium" health care plans (read: the better insurance plans)....not so fast. The insurance companies aren't going to just eat those costs...they're going to pass them on to the people who buy insurance. Think that lowering medicare funding is going to help people with medicare and medicaid find a doctor who will accept their insurance? I cannot emphasize enough what a victory the republicans scored (thanks to an independent) in keeping out the public option, but damage is going to be done, and a lot of it. Oh...and so much for reproductive rights, or a women's right to choose.

Change is probably coming, but you'll soon enough find out that it's not the change you were hoping for. You don't need to believe me now, and you can comment what you want, because you'll see soon enough. Fortunately, there is work left to be done. The senate bill has not yet passed, and if it does, it needs to be combined with the House bill. I can only hope that they either can't figure out how to do that, or that the republicans can stall it long enough to get themselves more votes in 2010. And make no mistake...they will have more votes in 2010, after the disaster that Obama and the democrats have created.

some good news today

I found out that I passed both my peds and psych subject exams, which I took two weekends ago. And, although I was a little worried about failing them, I wound up doing a lot better than I had expected. So, since I got good evals in both and passed the exams, I will honor my first two rotations. Now I just have to hope that I can continue to keep up this pace. At the moment, I have most of the residents at my IM rotation loving me for finally getting a major computer program fixed. I've managed to go 6 weeks, twice, without pissing anyone off, so I just have to make sure I can do it for 12 weeks straight now ;)

To everyone who thought I couldn't keep my mouth shut when I really had to...I told you so!

Oh and by the way...Rome pictures have been added to flickr.

one week down

...and 11 more to go! I have a feeling that this is going to be a long rotation. Internal Medicine is a whole lot of talking and writing, and not a lot of actual do-ing. For your info, I'll give you a little run down of how our day goes:

Get there around 6:30 and update the sign-out (a database with all of the patients assigned to our team). Once that's done, I usually walk around or check the computer to see how my team's patients did overnight. At 7:25, there is a short meeting, just to see how many patients everyone has, and redistribute as necessary. From then until noon, it's mostly just rounding and seeing patients. At noon, is noon conference (appropriately named). Some are more interesting than others, but all of them are a full hour lecture, so not terribly exciting. They do serve lunch there sometimes though, which is nice. I really love drug reps!

After noon conference, you see patients some more. Again, there is usually plenty of time to study, research, or do whatever you have to do. This may change though once I get on another team, since there are no teaching rounds on my current team. I did get lucky though, and I think I'm on the one team of two students that will get both Christmas and New Years off! We also change teams every two weeks, so I'll get the chance to work with many different doctors and patients. The day typically ends around 4-5, although sometimes a little earlier or later. We do not ever have overnight call, and we don't work many weekend days, so it's a pretty nice schedule!

I also like the hospital so far. Despite rumors I've heard, all of the residents have been very nice to me and very easy to get along with. Some are better teachers than others, but no one has ever been nasty when I've asked a question. There is a huge variety of patients and I think that by the time this is over, I will have seen pretty much anything the step wants to test me on. They also have a pretty nice computerized medical record system, which makes everyone's life easier. So, my current conclusion is that it's a good program with good residents, if not the most interesting rotation. But, that's just because I'm not personally particularly interested in IM.

First real day of call

Today was the first day that I stayed at a hospital past 5. Not only that, but it's also the earliest I've ever gotten to a hospital (just before 6:30AM). I wound up getting out just before 8PM, after a very busy long call. We started the day with 4 patients. After call, we now have 8, and my partner team also got 4 more. Fortunately, only one doesn't have insurance, so that's the only one we'll have to round on.

I also earned myself some brownie points, although most people won't realize it until tomorrow. There's a little program we use called signout, to update the patient information sheets every day (or a couple times a day). Even though just about every resident and student in medicine has to use it, it was only on 2 computers. I managed to get it working on another computer, and am working on a few more. But, at least there are now 50% more computers running the program!

Well, that wasn't so bad

The first day of IM went OK. Given, it was just orientation, but could have been much worse. Turns out, I overestimated (rather, was given wrong information) on how often I'll be working late. Actually, I'll only be there late once every 4 days, and even that is only until around 8PM. My senior resident seems to think that on most days, we'll be out around 4. Still a long day, considering we have to be there around 6:30, but not awful. I'm also not sure what's going on with holidays. Unfortunately, and for absolutely no good reason that I cant think of, students currently have to work either Christmas or New Years. There's really no good reason for this, but fortunately one of the senior residents agrees, and is working on having it changed. I'm not holding my breath for the change to happen, but it would be nice. It was also nice to see that of all the senior residents we heard from today, all felt that it was a medical student's job to learn, not to be scutted out all day. We do have to update the patient information every morning, which is basically scut work, but it shouldn't be that bad. Like the other rotations that I've completed, it seems like for the first week or two, I'll just be figuring things out as I go.

One exciting piece of news...I got a pager today! Well, it's not really that exciting and I'll probably wind up hating the thing, but I like it at the moment. Since no one in the world except doctors use pagers anymore, it makes me feel very doctor-ish. I've also ordered a new lab coat (without AUC's logo) and some books to go in the lab coat, so that's even more doctor looking. In less than 2 years, I won't have to pretend anymore...that will be nice.

goodbye, sleep

Today was my last day of "vacation." Tomorrow begins 7.5 months of a minimum of 70 hours a week, with absolutely no vacation. I have to be at St. Agnes tomorrow at 8am for orientation, but I'll probably have to be there around 6:30AM after tomorrow. From what I hear, IM is 70-75 hours/week. Surgery and ob/gyn will both likely be worse, and I have no break in between any of them. I was also just thinking tonight...I'm glad that St. Agnes IM apparently doesn't have night call, but I will have late call every 4th day. That means I'll get home somewhere around 11-11:30 PM (after getting in at 6:30AM), just to go upstairs, fall asleep, and wake up a few hours later to do it all again.

It's been fun, sleep. I'll miss you....

two subject exams down

...three more to go. today, I took the psych and peds subject exams. Neither one was unfair, but they were not easy either. Peds was harder, but psych was definitely trickier than I expected. But, I'm not really worried about them anymore! Right now, I'm just happy that it's snowing here!!! Having been in the caribbean for the last two winters, it's been a while since I've seen snow, and I sure did miss it. It's very pretty outside, at the moment. Unfortunately, I won't have any time this year for a real ski trip.

I did get to talk to a coupe people who did IM at St. Agnes recently. They were able to tell me the schedule, which is actually not as bad as I was expecting, but they gave completely conflicting reports on how it was. One girl liked it, the other person thought it was the worst thing that could happen to her. I'm guessing it probably depends on the person, like most rotations. Many people hated my psych attending, and didn't do well, but I liked him a lot and did very well, so I guess I'll just have to find out on my own on Monday. Fortunately, I found out that I get every other weekend off, and the opposite weekend, I only have to work either Saturday or Sunday. There is also no overnight call!

Now that I have a bit of a break, I think I'm going to edit some pictures and then go to the firehouse later tonight!

It's actually a lot prettier out now than this picture (it's from a couple hours ago), but it's getting dark, so probably not enough light for an iPhone pic. That, and I'm lazy

One holiday gift, figured out

Mom: What's this passport studio thing that just came in the mail today?
Me: It's the gift I asked for that you apparently ordered for me. Thanks!
Mom: Oops.... [hangs up phone]

surgery is awesome!

I know I still have yet to do my surgery core, but I'm pretty certain that it's what I'm going to go into. Yesterday, an ENT let me go in with him to two of his surgeries...a tympanoplasty and a neck resection. So, I got to spend about 6 hours in the OR, which made me very happy! The surgeries were both very different and very interesting to watch. The tympanoplasty essentially involved cutting most of the guy's ear off from behind, and then fixing the ear drum through that hole. The neck resection involved cutting open a guy's neck and then removing the submandibular gland and nearby lymph nodes....very cool stuff! The attending that took me and his residents were all very friendly and willing to answer any questions. Fortunately, I read about the cases the night before, because they also did just a little pimping. 3 months cannot come fast enough! But, I'm still a little excited to start IM.

I also found out yesterday that heather tried to have Target print a picture that I had taken and edited for a gift. They declined it saying they believed it was a professional picture with copyright. I'm kind of happy about that.

daily update

Looks like I've been absent for a while. Well, at least I haven't been as absent as a fellow blogger, who shall remain nameless (but is linked to on the right side of this page). Again, mostly because I don't have that much exciting to write about, since I'm currently on a 2 week break, before starting IM next Monday. I'm still working on editing the Paris and Rome pictures, but I'm hoping to have them done before IM starts. Tomorrow, I'm going in with an ENT to observe some surgery (thanks to Heather), which should be pretty damn awesome! I still have a little while to go before i do my surgery core, but I'm getting to watch little bits here and there, which holds me over. Have I mentioned that I really love being back in the US?

Since I have nothing more exciting to write about at the moment, here are a few pictures from Paris! I sometimes imagine that people actually get excited about me posting pics....waiting for them with baited breath. So, in my imaginary world, I'm now helping to hold you over. Many many more to come.

It's the simple things

Oh how I've missed you, Taco Bell



-- Post From My iPhone

AUC health insurance crisis!

AUC just sent out a letter that all students will be required to use AUC's insurance provider, for a fee of over $300/semester, no matter your age. The problem with this is that AUC's insurance provider covers almost NOTHING....it's among the worst insurance policies in the country. And, many of us in clinicals already have FAR superior insurance, with a yearly contract. I talked to Ms. Sanchez at MEAS, and it sounds as though she's already gotten a ton of calls about this, since it's going to cause major issues for almost every student. She encouraged me to e-mail her with why this policy sucks (my words, not hers), so she can try and figure out a solution. If you are just as outraged as me, please send her an e-mail at ssanchez@aucmed.edu.

Please do keep in mind that this was not her policy decision, and she was very nice on the phone...so maybe best to send a nice e-mail, while still expressing how awful this decision is.

I'm home!

And, with the return home, I've also got my amazing FIOS internet connection back. So, pictures are being uploaded to flickr as I get a chance to edit them. You can check them out at http://flickr.com/photos/slevit1. Here's a few:

Later, I'll write my overall impression of the rotation. But for now, I'm in desperate need of some good American food!

oh I can't wait to go home tomorrow

I'm exhausted, so I'm not going to write much right now. In short, I loved Rome, and I HATE HATE HATE public transportation, particularly London public transportation. I cannot wait to be home tomorrow at around 5:30 PM. At that time, I will be in a good mood. At the moment, I'm exhausted, still need to pack, and am not in a good mood.

almost time to go!

As happened in psych, I'm finally starting to feel comfortable in a rotation and finally feel like I know what I'm doing, and it's just about time for me to leave! At this point, I feel like I could see most pediatric patients and have some idea what's going on, and how to treat it. But, I can't say that I'm sad that it's almost over either. I've been ready to get back home for a while now. And, since my next couple rotations are twice the length of my previous two, I should have plenty of time to remain in the rotation, even after I'm finally comfortable.

For the moment, I'm just focusing on the fact that I only have two days left of peds, and they'll probably be pretty short days! Today was a half day, since the UK students are always off half day to go play sports. I was helping out one of the docs in the NICU though, so I stayed until around 1. However, that apparently made me an overachiever. Only 4 or 5 other students (out of about 15 total) decided to show up today. The work ethic amongst med students in the UK is much different than in the US, and you can get away with just about anything here. I guess that since the attending was at another hospital and there was no scheduled teaching, they just didn't feel like coming. I'm hoping the fact that I always show up is reflected in my evaluation!

last Tuesday in London!

Sorry I've been gone for a bit (again), but I was away all weekend, and then had to buy more internet access. Have I mentioned that I hate the internet in the UK? Anyway...I was in Amsterdam this past weekend and that city is amazing! It's very pretty, has lots of neat sights to visit, and the red light district is insane. Pretty much everything is legal there...it has to be the easiest place in the world to be a cop. Unfortunately, I didn't bring my camera with me, so I only got iPhone pics. I did not expect the city to be as pretty as it was, I didn't want to carry around the extra weight, and the weather was supposed to suck both days that I was there. Turns out that it mostly rained at night, and was pretty nice during the day, especially on Saturday. Oh well, the memories will remain in my head, just not shared on flickr this time. I will definitely be bringing my camera to Rome next weekend though!!

This week (my last week in the UK), I'm spending my time in the NICU. Today was probably the best day of the whole rotation. I'm following around the resident who gets all the pages for the high risk deliveries. Today, I saw my first c-section delivery. And then, I saw three more, including one emergency c-section on a 29 week old premature baby. For those who don't know, 40 weeks is full term, and 28 weeks is extremely premature, almost always requiring life support. Anything less than 26 weeks, probably not viable. So, 29 weeks is pretty darn small! It amazed me how fast the baby gets out in a c-section! The whole operation takes about a half hour or so, but almost all of that is closing the mother back up. From the time they make the first incision to the time they have the baby out is probably less than 5 minutes. In the emergency c-section on the 29 week old today, the baby was out probably less than 30 seconds after the first incision! Fortunately, the neonatal team was able to resuscitate the baby quickly, and it appears to be doing well now. I was very excited to finally be spending some time in the OR! It was pretty obvious to the neonatal resident that I really liked watching the surgery, so she let me watch them for most of all 4 c-sections. I really cannot wait to get to my surgery rotation. But, even more than that, i can't wait to get back home Monday!!!!!

stupid clouds

Yeah, I've heard that the UK is always cloudy, but I didn't really believe that an entire country could remain under perpetual cloud cover. However, despite a couple nice days here and there, that does seem to be mostly the case! I woke up this morning all excited because after about a week of bad weather, it was finally sunny. There was actually not a cloud in the sky this morning! But, on the way home, at only 1PM, I noticed that it was not nearly as bright outside anymore! Now, at nearly 4, the sky is completely covered in dull gray clouds again. It's pretty depressing.

What's not depressing though is how early we get out every day! I don't remember the last day that I was still at the hospital at 4. I'm not going to know what to do when I actually have to work a full day in my next rotation. Or, worse yet, actually have to work weekends! But, I do need to get some studying done today. I really want to finish reading the whole Blueprints Pediatrics book before I leave London...something which should definitely be possible if I can make myself read every day. I'm already over 1/3 done, and I didn't start until recently. So, I guess I should get to it...

Hello again

Sorry about the couple day absence; I didn't forget about blogging, I was just away in Paris for the weekend! First, the bad...I got sick, AGAIN!! It seems that I just cannot be healthy in Europe! I got sick the day before I left for Madrid, causing me to be sick the whole weekend, and got sick again on the way to Paris, again causing me to be sick for the whole trip. And then, to top it all off, when I got back from the trip and just wanted to go to bed, the train back to my town was not working. So, I had to take the tube and buses, which cost more and take twice as long! Then, the elevator in my building was not working. Today, since I've been sick now for over 2 weeks, I decided not to go into work, and instead waited 3 hours to see a doctor. In the end, I wound up with a prescription for acid reflux medication (which I've been buying over the counter, for too much money), and Augmentin, an antibiotic for probable bacterial sinusitis. So, hopefully it will all work, and I'll be better soon.

OK, now the good....Paris was as beautiful as I figured it would be, and the major sights are even more impressive in person than they are in pictures. It was cloudy and cold for much of the trip, but the weather did clear up while we were going up the Eiffel Tower, which allowed me to get some pretty spectacular pics. Unfortunately, I can't upload them until I'm home, since the internet here kind of sucks. I also had the most amazing hot chocolate in the world at a place by the Louvre, who's name I unfortunately can't remember. If you know the place I'm talking about, please leave its name in the comments. I know it sounds vague, but if you've been there, you know what I'm talking about! And, although I find the enormity of the Notre Dame cathedral a bit absurd, given that it was built to worship an imaginary man in the sky, it sure is impressive! I did find it a bit odd though that the place is loaded with tourists taking pictures, while services are going on. But, that did not stop me from being amongst the tourists taking tons of pictures! I also ate a bit of everything that I considered necessary in France, including French bread, croissants, French cheese, and French wine. All of it was equally delicious. I have no desire to go back to Madrid, but I would definitely like to go back to Paris one day, preferably with a girl this time, when the weather is a little nicer!

AMATEUR TRANSPLANTS: London Underground LIVE

OK, I lied. Here's the London Underground song. Warning, the language is NSFW. If you've never been in London and can't figure it out, the London Underground or Tube is the London Subway system. Although the London Underground is not currently on strike, the post office is, and my feelings for them at the moment are similar. This is the song that made them popular, outside of medical students.

Anaesthetists Hymn

Thanks to one of my UK colleagues, i discovered this group last night. I spent about an hour and a half going through all of their videos. They're not all medical related, but seeing as I"m a med student, I figured I'd post a couple of the medical ones. If you wanna find others, just run a youtube search, or maybe I'll post more later. Their London Underground song is pretty great.

to unlock or not to unlock

So they came out with a ridiculously simple unlock for the newest version of the iPhone software today. If they had come out with it 3 weeks ago, I would have unlocked my phone immediately. But, I've been dealing with not having the iPhone now for the last 3 weeks, and I have less than 3 more to go. So, I'm debating on whether or not I should unlock it and get a new SIM card. It really wouldn't cost much of anything, since I need more minutes anyway, but I'm thinking it's probably not worth the effort, to use for only 2 weeks or so. And, since there is NO cell reception in Queens hospital, where I'd usually want to use it, I wouldn't get that much use out of it. I think I'm just going to wait until I get back home, to remember how wonderful the iPhone really is. Damn you, hackers, for not doing this 3 weeks ago!

Great News!

I talked to my consultant physician today (attending) about my desire to stay at Queens hospital for the rest of my rotation. I kinda figured he'd let me stay, but it's nice to have it confirmed. So, I am officially done with King Georges and at Queens for the next 3 weeks! This means that I'll get to spend a week in the NICU (which they don't have at KGH) and also get to spend time in the peds dept. without any other students. The consultant does his lectures in 4 week blocks. Since this is my 4th week, by the time they switch back to KGH, I'll have been to all the lectures. Since the rest of the AUC students started later (one just started today), they'll have to go back to King Georges with the other students. So, I'll be the only student left at Queens, which will allow me to do pretty much anything I want in the peds department. Definitely a positive development!

Back to the gym

So, I was standing in front of my bathroom mirror today (as I often do) and I became a little upset. Although the less-than-delicioius UK food has caused me to lose some weight, my chest and arms have also been slowly deflating. So, I joined a gym today. I actually would have done it much earlier, but I've been sick pretty much since I got here. Now that I'm better, I could finally go join! It's not too expensive, and a reasonably nice place. Should at least hold me over until I get back to Federal Hill Fitness (best gym in Baltimore). Other than that, not much to write about. Gonna take some Ritalin and study for the rest of the night....fun fun!!

what a boring saturday

Today, I spent a large portion of the day completely deleting and then rebuilding my iPhoto library. For a while, iPhoto has not been working well for me, but it's probably my fault. Before I got a new hard drive in my old computer, I went back and forth debating whether I'd keep my pics on my computer HD or on an external HD. Since I kept changing my mind, pictures were randomly stored in both places, or one or the other. I moved things around a lot and also did some digging through the iPhoto library file (which you're not supposed to do). Somewhere along the way, things got very screwed up, to the point that I could no longer import photos from Lightroom. So, instead of fooling around with the library any longer, a job which had already wasted too much of my time, I just deleted the whole thing and started over. Fortunately, since I never really decided where to put things, I had copies of everything stored in a separate file. And, now that my computer has a much larger HD, I had it all stored on my computer.

Long story short...my iPhoto is working perfectly again and everything is where it should be. I still have to import some more pictures to iPhoto, but I'll get to that later. In short time, all of the pics will be properly organized in iPhoto (like iTunes, it automagically organizes everything for you, and you never have to see how it does it), and deleted from the random places that they were before.

After screwing around with iPhoto for way too long, I've gotten some decent peds studying in, both from First Aid and Blueprints. I think I'm going to go find some food, since I've hardly eaten today, and then come back to study some more. For the first time since I've been here, I've taken my Ritalin. I really need to start taking that stuff every day, because it sure does make me productive!

NOOOOOOO!!!!

I'm going to miss my opportunity to get a Free Chipotle Burrito! Chipotle is one of the best foods I've ever put in my mouth, and in this whole country, there's not a single location! English people really have no idea how to eat! For those of you fortunate enough to be in the US, dress like a giant foil wrapped burrito (or anything else on their menu), and get a free burrito!

Edwards Syndrome...something you don't see everyday

Today, I saw a baby with Trisomy 18, otherwise known as Edwards Syndrome. As the name implies, it occurs when a baby has three copies of the 18th chromosome, instead of the usual 2. As with most chromosomal abnormalities, it's a particularly tragic disease. It usually causes a large number of problems, including serious kidney and heart defects, and multiple dysmorphic features such as rocker bottom feet, a short sternum, and micrognathia. The babies often die before 3 months of age and almost always die before 1 year old. Unfortunately, the baby that I saw to day is extremely sick and will most likely fall into the first category. He is probably the smallest baby currently in the NICU, and makes absolutely no respiratory effort. It's hard not to feel bad for the parents, who will probably be making a very difficult decision shortly.

Seeing conditions like this really help to learn the disease. It's one thing to read about a rare disease in a pathology book. But, it's entirely different to actually see someone with the disease in front of you. It associates a person with the disease, and makes you really want to go learn about it. In the future, I will be remembering a person, when I think of Edwards syndrome, instead of just trying to remember facts from a text book. The same is true of the many other childhood diseases I've dealt with in the last few weeks. Although peds is not my favorite rotation, I really do enjoy clinicals! It's easy to forget why you want to be a doctor in basic sciences, but clinicals brings it all back!

Moving right along

As of today, I'm half way through with my peds rotation. Time in clinicals is flying nearly as fast as time in basic sciences. Of course, my next two rotations are twice as long as my current and previous rotation (12 weeks, instead of 6), but things are still coming along pretty quickly. It's amazing how much of a difference one week can make in my outlook of things. Last week, I was thinking how long I had left, since I had only completed 2 weeks, with 4 still to go. Today, I'm happy that I'm almost halfway done!

I'm also pretty happy that I'm nearly finished the two rotations that I was least looking forward to. Although, I have to admit, I did like psych a lot more than I had expected to, and I actually miss the rotation. Looking back, I really did like my attending, and I even enjoyed most of the patients on the unit. Unfortunately, I like peds a little less than I expected to, but I think that has something to do with the fact that I'm doing it in the UK.

Mostly, I'm looking forward to IM and surgery; IM because it should actually feel like practicing real medicine, and surgery because that's what I think I want to do. It really won't be long now before I have to start preparing for step 2, and that scares me a little. But, that means I'm getting closer to finishing the 4 years I wasn't sure I'd ever start, more or less finish!

sorry for the neglect, blog

Sometimes, I just stop blogging. I'm not sure why I do it. But, I'm sorry anyway, and I'll try to keep it up again!

Anyways...where to start?

I'm now just about done my first week at Queen's hospital, and I am liking it a lot better than KGH! Largely because I can now easily walk to work, but also because I like the rotation better at Queens. I feel like I've learned more in the past week than I learned in two weeks at KGH. Queens has more patients and sicker patients. And, I haven't even started clinics or been to the NICU yet! People doing clinics seem to like that, so I'll see how it goes next week. I'm really hoping that the attending will let me stay at Queens for the rest of my time here.

Last weekend, i visited Bath, Stonehenge, and Windsor Castle. I took the tour with Evan Evans Tours, and it was a very good experience. Wound up being another beautiful day for sightseeing, with sunny skies and cool (but not cold) temps. Windsor Castle was as impressive as I would have imagined (for a royal castle, still regularly in use), Stonehenge was larger than I pictured it, and Bath was just a beautiful city. I wish we had more time to walk around Bath, but it was a long day and we had to get going after about an hour and a half. You can't get very close to stonehenge, but it actually makes for better pictures, since there aren't tourists trying to hug the rocks. There is only one night per year (I think the summer solstice), that they actually let people go up to the rocks. But, you're plenty close for pictures. Unfortunately, internet here largely sucks. For some reason unbeknownst to me, the companies seem to consider 3GB per month fair "unlimited" internet use. Well, it's not, at all. Because of the insane cost of bandwidth, I can't upload all of my pics to Flickr. So, unfortunately, my blog will have to remain uncharacteristically black and white until I return home. However, have uploaded many of the pictures to facebook, since that uses up less bandwidth.

This weekend, I don't have any plans yet. But, I have planned a trip to Paris for next weekend. Although I knew it was a bad idea, I tried to be nice and wait for another person to get their schedule before making plans. Because of that, by the time I knew what was going on, the prices had jumped up for this weekend, as I knew they would! But, I guess it's not awful to save a little money and sleep in for one weekend. Maybe I'll head to cambridge or oxford for a day trip.

As an aside, I'm REALLY missing good sushi, good mexican, and good meat (for reasonable prices). I can't wait to get back to US food and internet!

Last day at King George!!! Woohoo!!

As the title implies, today was my last day of peds at King George! Starting Monday, I'll finally be at queens, which means a 5-10 minute walk every day, instead of a 10 minute walk and then 20 minute bus ride. Also, since all of the sicker kids are at Queens, should be more to learn.

So far, here's what I like and dislike about the UK rotations:
Like:
1. Good teaching, and it's frequent. They usually start late, which is annoying, but most of it is very relevant and very good. Almost every day, at least once a day, we sit down for 45 minutes to an hour and discuss a particular topic. So far, they've included diabetes, cystic fibrosis, evaluation of headache, seizures, fever, rash, etc., all of course related to pediatric presentations.
2. It's easy. Our regular hours are 9-5, but I've never actually stayed until 5. Every wednesday is half day, and I was out by 1pm for the last 3 days. If you need to be somewhere, just go. The UK students are usually out even before I leave!
3. You can see as much or as little as you want, as long as you ask. Want to draw blood or start an IV? Just ask. If you want to spend all day on the ward and interview all the patients, you can. If you want to go to the A&E (ER), just go, ask for a registrar (resident), and see patients. Need to spend more time studying? Go home or to the library and study.
4. Travel wherever you want around Europe on the weekends
5. No call, nights, or weekends (at least not in my rotation)

Dislike:
1. Typical stuff that goes along with not being in the US - it's more expensive, food is not as good, internet kind of sucks, no iPhone access, etc. etc.
2. I would like more of a schedule and more direction on where to go and what I'm supposed to be doing. Things seem very haphazard. If they feel like teaching (which they often do), they'll just randomly announce in the morning to be in the conference room whenever they think they want to teach
3. All of their drug names are different, so it takes a while to have any idea what drugs they're giving. They also use different units for many of their labs, so it takes a while to figure that out too. A glucose of 11 is VERY low for us, pretty high for them (multiply by 18 to get our equivalent unit). Finally, they use drugs that we don't use, and don't use drugs that we do. For example, they still regularly use chloramphenicol for peds and they don't use sulphamethoxazole. Is it any wonder that they have like a 75% resistance rate to trimethroprim?
4. They do things a bit differently here and I kind of like things the way I'm used to. Doctors here regularly have to run around looking for x-rays or labs (nothing is computerized and they don't seem to have techs). One doctor told me he spends 30% of his time treating patients and 70% running around looking for things. Nurses also usually can't start cannulas (IV's) or draw blood.
5. Things are SLOW! Patients are regularly held overnight (or longer) while they wait for blood results, scans, dietary, EEGs, etc.
6. Did I mention it's expensive? The dollar kind of sucks.

WTF, Romford?

There is not a single Taco Bell or Chipotle anywhere near me. In fact, I don't know that there's one anywhere in London! Why would they do this to me? How am I supposed to get my fix? This is crap...i'm not happy.

A bit of a slow down

Unfortunately, I have not really seen anything exciting in peds since the last week. Part of this is likely due to the fact that for some reason unbeknownst to me, we have to rotate at King George's hospital for part of the time. Unlike Queen's, King Georges doesn't have any peds or neonatal intensive care, so all the really sick kids are elsewhere. There is nothing at King George that isn't at Queens, but lots at Queens that isn't at King Georges, so I really can't wait until this week ends and we switch hospitals. Not to mention the fact that you need to get up about 45 minutes earlier to commute to King Georges.

Today, we had three teaching sessions. They were all pretty good, but the doctors really like to start late. Kind of inconsiderate in my opinion, especially when we have other things scheduled to do, but maybe that's just the status quo. Since this is only my second rotation, and only rotation in the UK, I really don't know what's normal. So, I just keep quiet and do what they say. This strategy worked well in my last rotation and got me a great eval, so hopefully it will work again. I know...me keeping quiet...hard to believe. But, at the moment, my grades, and very possibly my future residency placement, depends on it.

Over the weekend, I went to Madrid, with Josh and Song. It's a beautiful city, but I was pretty sick on Saturday, which made it much more difficult to really enjoy. I tried some paella and sangria, but could hardly eat any of it. However, it was definitely the best sangria I've had in my life! When I get back to the US, I'm going to be in search of somewhere that can come close. At some point, I'll upload all the pictures I took. Hopefully, even though I was pretty miserable walking around, the pictures will make me remember it in a better light. At least if I was going to be sick, it turned out to be an absolutely perfect day for walking around, with temps around 65-70 and not a cloud in the sky. The only problem with Madrid is that either no one speaks English, or no one will admit to speaking English (I suspect the latter). This made it more difficult to get around and impossible to argue with the thief of a taxi driver we wound up with.

At the moment, I'm slowly trying to recover from whatever virus is currently attacking me. Good news - it appears my immune system is starting to kick some ass. I now am pretty hoarse and cough a lot, but I'm feeling much better than I did Saturday. I bought some dextromethorphan for the cough, so hopefully that will help.

Peds in the UK

Today, I finished my 3rd day of paeds (as the spell it in the UK). Not much of a milestone, but it's progress. The biggest shock has been how different the UK medical education system is than ours!! First, they do not go to college; they go straight from high school to med school. Then, med school is either 5 or 6 years, depending on if they get a degree or not. In either case, unless you come with a degree, med school is considered undergraduate. Then, after graduating, they begin residency as a FY1 and then FY2. During these two years, they rotate through a little of everything, and don't specialize at least until they reach their third year. In their third year (which they have to apply for, again), they're considered house officers and usually start their specialization (although not always). After a couple years of that, they apply again to become a registrar. At this point, they're in specialty training and are pretty senior. They can spend a pretty long time here...basically, until the consultant (their word for attending) thinks they're ready. If they're good, it can be just a couple years. Otherwise, can be longer. It's not unusual to take 10 years to complete surgical training (compared to 5 in the US).

However, there is a trade off, which is that they work MUCH fewer hours than US students and residents. I believe that their maximum workweek is 48 hours, which is not exactly strenuous. And medical students have it pretty darn easy! My schedule is technically 9-5 (which is already easy), but most of the students are gone by 2 or 3, since the consultants really don't care what you do. Basically, you get as much or as little as you want out of it. Even in surgery rotations, you get out in the early evening or late afternoon and have weekends off. All students also have wednesday afternoon off, to go play a sport (or just go home). And, my attending said he knows that we probably had a hard week, so we should just take Fridays easy and leave early! If you want to go to the ER or OR, you're pretty free to do so. Or not, if you just want to go home. If you don't like surgery and don't want an insane schedule, this is definitely the place to come!

However, you can also learn a lot, if you want to. Most of the registrars like to teach and do it pretty often. We usually have 1 or 2 teaching sessions per day. Today, I saw a baby with CHARGE syndrome and Down syndrome, as well as learned how to do a baby check. We also had a lecture on Down syndrome. Tomorrow, we have a lecture on childhood asthma and another on cystic fibrosis. For the rest of the night, I'll probably spend a little time reading up on the, so I can appear smarter than I really am ;)

3rd year financial aid

I was reminded that I never posted on how financial aid works for the third year. I guess that's because I found that it works basically the same the previous two years...same paperwork, same process. The only difference is that once the loan checks arrive at MEAS, they send them to you to be signed, you send them back, they deduct their part, then they send you a new check. Similar to what they do at AUC, but obviously takes longer, since they have to mail everything instead of just having it waiting for you at registration. MEAS will mail you a packet once you leave the island, which has all the forms you need in it for your first clinical semester.

Fortunately, the financial aid office is also very helpful and returns e-mails quickly. If you do have any questions, you can just e-mail them and they'll usually send an answer within the day.

no iphone!! :(

I have figured out three things so far, since I've been in London.

1. A "subway" in London is not the same thing as in the US, at all. Here, a subway is just a walking path under a road, so you don't have to cross a very busy roundabout. I crossed quite a few very busy roads before I figured this out. What I was thinking of is just called the underground.

2. I do not like pounds. They're too big and they're all different sizes! Who came up with the idea of money that does not fit in a wallet. And coins? I don't much care for them either!

3. I really miss my unlimited data iPhone service! I am absolutely lost, both literally and figuratively, without it. I'm going to try to figure something out with O2 (the local cell company), but I'm not holding onto much hope.


I have conveniently provided this stick figure drawing, so you can see approximately how large their money is!

I'm in London!

I guess I have a bit of catching up to do on here! I finished my psych rotation yesterday at 1pm and was on a plane here later last night. Unfortunately, it was an overnight flight, so I'm pretty exhausted. I've gotta say...I'm a big fan of British Airways, but I still cannot sleep on a plane. I was in coach, but the seats were more comfortable than usual, reclined about twice as far, had video on demand at every seat, and they actually served 2 meals! For free! And free alcohol!

I arrived in london at about 5am eastern time, 10am London time. It was a little over an hour cab ride to get to my hotel for the next few days, but he went through the city and showed me the sights. Although I still have to go back (probably tomorrow) to really explore and take pictures, I've already seen Westminster Abbey, London Bridge, London Tower, Big Ben, Buckingham Palace, the London Eye, and a few other things. I also walked to Queens hospital, so I could get an idea of where I'd be working for the next few weeks.

The hospital is brand new, and looks it on the outside. The inside does not look quite as nice as a US hospital would, but I haven't seen the patient care areas yet either. I also saw a few ambulances, which were very different than what we have in the US! For one, they've got lifts on the back!! They NEVER have to lift a stretcher, which must be very nice. But, they're quite a bit smaller than what I'm used to at home.

I've gotten a few pictures of the hospital and Romford, but I forgot my memory card reader. So, getting a cheap one tomorrow is definitely on my list of things to do. Once I go into London, I can't imagine it will take too long to fill up the card. At the moment, I've got pretty decent internet in the hotel. So, I'm hoping it's at least this good in my apartment on Monday!

Speaking of hotels, this place barely qualifies as such. The staff is very friendly and I suppose it's got everything you need, but geez these rooms are small!! We're talking basically a double size cot, shower right behind it, and a tiny bathroom that you can hardly turn around in. Compared to this, a typical comfort inn looks absolutely luxury. I guess you could call it cozy though. I think it's time for me to go to bed! It's only about 6PM here, but I'm trying to get rid of jet lag!

DO NOT MOVE EMERGENCY VEHICLES!!!

Today, I'm going to share with you one of my greatest pet-peeves in the world. Occasionally when I'm driving the medic unit or some other emergency vehicle, some dim wit will walk up to me and ask me to move the emergency vehicle because it's blocking their car, road, or whatever. If you're one of these people, please allow me to save you some time...NO, I will not move the emergency vehicle for your convenience.

The thing is, I probably parked it there for a reason. If I'm driving the ambulance, I probably parked it in a place where I will have best access to the side compartments and the back for loading the patient. It's also very possible that I intentionally blocked traffic to protect myself, the rest of the crew, and the patient from cars passing us. If you haven't noticed, people tend to not do their best driving when they're trying to simultaneously view an accident scene; pretty flashing lights are just sometimes distracting.

If you see my ambulance somewhere with the lights on, and I'm blocking your way, please consider that someone has called 911 and needs help! Your ability to get out of a parking space, or continue on that road, is at the very bottom of my list of priorities. In fact, it's not even on my list of priorities. But one day, when you inevitably call 911, you'll appreciate that the paramedic is more worried about you than the people who want to get out of their parking spots.

One last thing...whatever you do, don't get in the emergency vehicle and move it yourself!! This is called "unauthorized use" and will buy you a ticket. Someone at UMBC is about to find that out.

Spring Grove Museum

If you ever get the chance, i'd recommend heading over to the Spring Grove museum. It's only open on Thursdays from 9am - 12pm, which is why it's taken me so long to make it over. It's run by a bunch of retired Spring Grove employees, who now volunteer to keep up the museum. It's not very large, but pretty interesting to walk through. Spring Grove was actually the second psychiatric hospital in the country, started back in the 1700's, so there's quite a bit of history to see there! Here's a couple pics. Sorry for the poor quality, but i only had my iPhone with me today. Check out my flickr site for many more. Clicking on any of the pictures should take you there.


This is the Foster Wade building, which is easily the creepiest building on campus. It's been locked up and condemned for many years, and I will not divulge if I've ever been in the building. If I had though, I'd tell you that it's far worse inside than out, especially at night, on Halloween! The dedication stone by the entrance reads, "Psychopathic Building," so that ought to give you an idea how old it is. This is only one part of it...it's a huge building.


If you weren't psychotic before you arrived at Spring Grove, this would certainly help to get you there!


The heavy restrain chair....this is what they used to get control of you before the days of chemical restraints


...or this


Some very interesting old articles...check out the titles!


Old electroconvulsive therapy (ECT) machine

My psych unit

I wasn't going to post any pictures of my unit, to avoid HIPPA violations, but then decided that posting a picture of the signs outside doesn't violate anything. Although, I did have to be careful not to get pictures of anyone in the yard! So now you've seen a small part of the outside of my unit, and the medication book. My fellow med student got a picture of the two of us inside today, so that will come later.

I'm on a unit which has a lot of forensic patients (people with legal issues), most of whom are not allowed to leave the building, hence the fenced in courtyard. At every entrance, there are two doors, and you only unlock one at a time. That way, there's never an unlocked path out.

My new favorite thing...

Yeah, I know it's a bad picture. But, the green tab which is pulled out reads, "Doctors Orders, Routine." This is the medication book on my unit, and it's where we write all of the medication orders. Anytime I, or the attending, write an order, we pull this tab up to let the nurses know there's something new to do. Since I've become a big fan of writing medication orders, I've also become a big fan of pulling up this tab...seems very doctor-like. Yup...it's the simple things in life that make me happy. Why is writing orders my favorite thing? Mostly because it's the only thing I've done so far that I couldn't have done before this year of med school. Psych is not exactly packed full of procedures to do.

new weekend, already?

Looks like I've been slacking on the blogging lately! Sorry about that. Well, maybe that's because there's just not that much exciting to write about in the psych rotation! I don't have any fun pictures, since that's sort of a HIPPA violation. And, although Spring Grove is a pretty nice looking campus, my particularly building is not much to look at. Their are old buildings that are rich with history and old architecture, and others that are just old and boring; mine is the latter. I'm currently up to 4 patients that I follow, which is keeping me pretty busy. I've interviewed my first three and written notes on all of them, but I still have to find time to interview the 4th. That's going to be a little more difficult, since tomorrow I have to do a full admissions report on a new admit we got on Thursday! Fortunately, I am finally comfortable with my role and what i'm supposed to be doing on this rotation. But, it's taken a month to really get there, and I leave in 2 weeks!

Speaking of 2 weeks, I can't believe that I am headed off to London in less than two weeks! I finish psych in the early afternoon and board the plane to london later that evening! I really have not the slightest idea of what to expect. I think it will be an interesting and educational opportunity, but AUC really could do a better job of giving more information. As it stands, you pretty much just show up and figure it out as you go. But, everyone else has been figuring it out, so I'm sure I will too.

Oh, and nice job to the Ravens again today, now 3 - 0 for the season! Given, the Browns are probably the worst team in the league, but 34-3 still isn't too shabby. To make things even better, Pittsburgh and Washington both lost!! What a great day of football!

Weekend update

Congrats to the Ravens, who recently showed San Diego why you need to be afraid of the Raven's Defense! If I remember correctly, the Chargers made it within yards of the end zone 4 times, and once within inches, only to be denied touchdowns and have to settle for field goals. Yes, it's only 2 games in, but the Ravens are currently #1 in their division, and one of the best teams in the NFL! Hopefully, they'll be able to keep this going through the rest of the season.

In non-football news, I went to the MD Wine Festival with Heather, Nick, and Lizzy yesterday. It was $25 to get in, but you got a free wine glass, and I definitely drank my money's worth of free wine samples. You only get half an ounce per sample, but there had to be at least 30 or more vineyards there, and each gave 5-10 different samples. You could also get multiple samples if you wanted. Needless to say, I had plenty to drink and Heather wound up driving. Heather also wound up buying 4 bottles of delicious wine from Solomons Island Winery.

After a week of procrastinating, I also finished my psych rotation essay on schizophrenia....turned out to be 5 pages! I'm hoping this is the only one he gives us, but something tells me we'll be getting another. Tomorrow, I've got to finish up my second SOAP note, and hopefully interview and write on my 3rd patient. I'll also have to pick up a 4th patient this week, and then follow up with my current 3. Should be a busy week!

The Second Coming of Jesus is here!!

By second, I mean sixth and by Jesus, I mean season of The Office!!!! Forget writing my first note or my first order...THE OFFICE IS BACK TONIGHT!! I was just laying in bed, minding my own business, when all of the sudden, I hit the "DVR" button and there is "The Office," staring right at me! Time to go watch!!!!

Health Insurance or Getting Drunk?

Thanks Ray, for the link

My first charting and orders!

Today, after interviewing my first patient yesterday, I finally made my first entry into a patient chart (a rather long SOAP note) and wrote my first orders! While I was writing the SOAP note, it just felt like any other assignment and write up I've ever done. But, I'd be lying if I didn't smile a little when I put it into the patient's chart. It's different when you're writing it as an assignment, or writing it after you've actually done an assessment, know what's going on, and are part of the treatment team.

As far as my first order goes, I've decided to try and get my patient off of daily anti-psychotics, and give them a long-acting, once a month injection instead. Before I can do that though, I had to get blood work to check how fast he metabolizes the medication, to make sure I get the dose right. So, writing an order for lab work was my first official order! After putting the SOAP note in the chart, Dr. Gray brought me the medication book (where orders are written) and told me I forgot to write the order. I told him that I hadn't forgotten, I was just waiting until I typed up the note first. What I did not tell him was that there was NO WAY I was going to forget to write my first order! So, it's there now (countersigned by him), and will be done sometime soon. Once it's back, I'll be able to write my second order, and first medication order. I don't quite feel like a doctor yet, but I'm getting there.

Good news and bad news

The bad news is that my attending was out sick today. Hopefully, he'll get better quickly and be back tomorrow. The good news is that since he was out, and the other part time doctor on the unit doesn't think we should be around with no attending, we got off at around 12:30! I do love getting off early! It also gave me the opportunity to go get blood drawn for titers to all sorts of fun diseases. This was something I was supposed to take care of along time ago, but somehow let slip my mind. Fortunately, Spring Grove didn't ask for proof of immunizations, but the UK peds rotation definitely will! I was worried about when I'd be able to make it to the office, since I'm at work whenever they're open, but this unexpected time off gave me the perfect opportunity! Also, very fortunately for me, Spring Grove gave me a copy of my background check that they run on all the students. This saves me almost a full day, which I do not have, running downtown, waiting in a long slow line, and paying lots of money, to get my own. All in all, a positive day!

got my first two patients!

I technically got them yesterday, and I still haven't seen them yet, but I'm still pretty happy about it. We actually see patients every day, and I've been able to talk to any that I've felt like. But, these are the first two that I'm assigned to, and I'll be interacting with them more than any others. Each week, we'll be getting one more added to the list. So far, I've only read their charts. But, since the patients on my unit have usually spent years in and out of psych units, they have long charts! It's amazing how normal some of these people seem, until you get into their chart. With some of them, the psychosis comes out quickly, once you start talking to them. And, there are a couple that never seem normal, even when they're just walking around. The King of Africa guy has now changed his story...he is now the king of the world, an 8-zillionaire, and has white, black, chinese, and martian children. No, I am not lying about that last one and yes, he was serious. This is just a small sampling of what we hear in a day.

But, despite their psychosis, many of them are very friendly. When I walk in in the morning, I am almost always greeting by a couple of them, and many of them make sure to say goodbye when they see me walking out. Most of them are also usually more than willing to talk to you and answer just about anything you ask. Their answers may or may not make any sense, but they'll do their best.

I'm also liking my attending more. Although he does assign us homework nearly every night, it's not difficult or time consuming, and it seems like he's mostly concerned that you put a little effort into it, not so much if it's right or wrong. He also allows us more interaction with the patients than other attendings I've heard of. You do have to ask to do things and you kind of figure things out on your own, but he hasn't said no yet, and is always more than willing to answer questions or let you talk to patients. And, while I don't love any lecture, the few we've had so far have been useful and mostly interesting (we get 1 or 2 a week, and they're about 2 hrs).

Also, head on over to Trixie's site, to make sure she doesn't up and disappear!

I found shelf milk!!

It's the simple things in life that sometimes make me happy. Today, while shopping at Safeway, I came upon shelf milk...one of the only things I miss from SXM! It's real milk and I'm not exactly sure how they do it, but it lasts about a year in the pantry. Once you open it, it's good for about a week. My old roommate, who drank milk, said he could taste a difference. But, in cereal or protein shakes, it tastes exactly the same. I sure did miss that stuff, but I've got 4 cartons of it sitting in the pantry now!

Disney Pics

Yeah, it's been a while, but I've uploaded pics from my trip to Disney with Heather. If you're interested, you can check the rest out on my flickr site!