Almost...

Almost done with my last exam of med school. Well, not technically the last since I do have an Ob/gyn shelf coming up in a few weekends. But, tomorrow is Step 2 CK, and the last exam of med school that I will study for or care about. I know I haven't blogged in a while (again), but I think that studying for step 2 is a good reason to not blog every day!

I really don't know how I feel about the exam and my readiness for it. I do know that my averages in USMLEWorld have been improving lately, but I'd probably always feel like I could do better, if I just had another week. Eventually though, I'd probably just get to the point where I'd be learning new things, but forgetting old things. I'm hoping that right now, I'm sitting in the sweet spot of knowing just the right amount without forgetting anything. Today, I'll probably do a few more questions, but spend most of the day reviewing what I hope will wind up being high yield little facts. Mostly, that will consist of the notes I've made from USMLEWorld, as I've gone along.

For now, time for me to get to it. Last day of studying for a very long time....

Dear Asian dude

Whoever you are, I do appreciate that you read my blog and comment regularly. However, you'll notice that all of my blogs are written in English. It's not because I don't care about other languages, but because I just don't know any. I know a little Spanish, but not enough to write a blog post. I can write my name in Japanese, but that's definitely not enough to write a blog post. So, if you'd like to continue commenting, that's great, but can you please do so in English?

Thanks!

preparing for the step 2 CK

Of course, I don't have the results for Step 2 CS yet, but I've really put that out of my mind for the time being. For now, i'm focusing most of my energy on CK (the 9-hour multiple choice exam). I've been studying almost exclusively with USMLEWorld, and then using StepUp to Medicine to go over the topics I'm not doing as well in. I think I'm on pace to complete the Q-bank in the next week or so, and then I'll have time to go through all the questions I get wrong again. I'm also taking notes as I go through the Q-bank, and I go through them pretty much every day. Everyone I talk to always says the most important thing you can do is questions, and I'm trying to do more than I've done for any exam in the past, so I'm really hoping this strategy pays off for me.

Yesterday, I took the day off to go out on a boat with the family, my mom's friend from college (I think), and her kids. Being out on the water was definitely a nice break from sitting at my desk doing questions. But, now I'm paying for it by sitting inside on a beautiful Saturday. The one thing getting me through it is knowing that this is the last exam sitting between me and graduating med school!

So, a few more hours of studying today, and then crabs for dinner tonight!

Post Step 2 CS

Well, I hope that I can say that this is post step 2. Unfortunately, scores don't come for about 6 weeks since our 12 patient encounters have to be read and graded by physicians. I'm very hesitant to give any impression of the exam before knowing that I passed, but I'd like to think that I did. And, if I do pass, then I'll be saying that it really wasn't that bad.

For now, I'll attempt to give as much info as I can, without breaking any USMLE rules. I took the test in Philly. If you stay the night, I'd highly recommend the Sheraton, which is about 2 blocks from the test site. The room was surprisingly nice, and very comfortable. I hardly slept, but that was not the hotel's fault. Of course, I was very nervous going into the test site in the morning, but the proctors were all very friendly, and did a great job keeping the mood as light as possible. Standing at the first patient door, waiting for the announcement to enter, I got even more nervous. But, the nervousness subsided fairly quickly. The standardized patients were very good at their job, and until you heard the announcement that 5 minutes remain in the encounter, you could almost forget that the encounter wasn't real.

I usually finished with about a minute to spare, although I did come very close to running out of time on two out of the twelve. The same was true for the patient note...I generally had a minute or so to spare. You have to move relatively quickly, but I didn't feel particularly rushed, or that I didn't have time to think.

Of course, I'm not allowed to give out any specifics about any of the scenarios that I got. However, I will say that if you've read all of First Aid, you should be very comfortable with the exam. It really is an excellent book to prepare, and covers just about everything you'll want/need to know. Everyone told me this, and it's true, so I'll repeat it...First Aid is all you need for the exam. Buy the book and read the whole thing. Practice with other people if you can. Once I know how I did, I'll write some detailed advice.

Step 2 CS time!

I'm about to get packed and head for Philly for Step 2 CS! I actually made it through all of First Aid last night, which was where I wanted to be. So today, I'm going to get to Philly, find a cheesesteak, and the try to go through as much of the book as possible again tonight. Hopefully, that will be enough to prepare me for tomorrow. It's gonna be a long day, but it's got to be better than sitting at a computer for 8 hrs, which is what I'll be doing in another couple of weeks.

mmmm...cheesesteak


food porn

Same old posts...new design

Blogger added some new choices to spruce up the blog, so I've taken advantage. The blog's appearance may be in a state of flux, but everything else should remain the same.

Shanny's Wedding pics!

First off, Congrats to Shannon and Jason Askinasi! Shannon asked me to take some pictures for them, so I was glad to do so. Unfortunately, since I hadn't taken pictures in a while, I forgot some pretty basic things. First off, I took a whole ton of pics at a VERY high ISO, which I forgot to change back after playing around earlier. This meant that I had to do a lot of noise reduction after the fact, and I didn't get quite the pictures I should have. I also took a bunch of pics in auto mode, which I always complain about when other people do it with an SLR. Fortunately, their photographer noticed this and set me straight quickly! Despite all that, I still think I got a bunch of decent pics. If you want to check them out, they're on my flickr site, as usual. Here are a few:

And so it begins...again

I take Step 2 CS this Friday, and then Step 2 CK on July 27. That means that until the 27th, I'll be doing basically nothing but studying...something I have been not looking forward to since I finished studying for Step 1! But, like everything else, this time will probably fly by way too quickly, and then I'll be on to electives. I don't know how much I'll be blogging for the next while, because really, who wants to read about my studying? It's not exciting for me, so probably less so for you. However, I'll try to update my progress anyway. But, for now, it's time to get started...

Big day tomorrow

For me, it's a big day because it's my last day of Ob/gyn, and after 6 weeks in NY, I'm finally going back home! I would like to thank Flushing for the broken window, stolen GPS, and parking ticket. Only one more day tomorrow in clinic, spending most of the time staring at the wall because I don't speak the right language. It's a little awkward doing a pap smear, vaginal exam, and breast exam on someone you can't talk to, but that's the life of an ob/gyn student in Flushing!

However, for thousands of brand new residents across the country, tomorrow is an even bigger day! Every year, July 1st is the day that every new intern starts residency, all across the country. If you think about it, it's a little scary. According to some reports, hospital death rates jump up to 10% in July! After 4 years in medical school, where every patient encounter is closely monitored and you're not really responsible for much, you're all of the sudden a doctor, and the patients are YOUR patients! It's a scary thought, and exactly a year away for me. So, best of luck to all of the new residents tomorrow!

Bored and on call

Currently, I'm sitting in the residents lounge, on one of the way-too-comfortable sofas, taking a short break from studying. There are very few patients here today, which leaves me with very little to do. At some point, I'll have to go record vitals (since there is no computer charting here), but I'm not feeling quite ready for that yet.

I had Indian for lunch today, and my stomach is not thanking me at all for that. The hardest thing to do today will likely be deciding what to do for dinner. I'm not complaining though...I have managed to get a decent amount of studying done, although the end is nowhere near in sight, and won't be for another month. Ok...i think I'll go find vitals now.


- Posted using BlogPress from my iPad

Location:Hawthorne Ave,Flushing,United States

last 24 hr call for the next year?

Unfortunately, I've got another 24 hr weekend call tomorrow, but it's Sunday, which is much better than Saturday. At least with Sunday call, you get Monday off. However, even more exciting than only having Monday off from clinic is the fact that this is probably my last long call of med school! 4th year electives typically have better hours than 3rd year cores (unless you pick something like neurosurgery), so this should be it for me. I'll definitely be doing some nights throughout my two months of ER, but they'll just be regular night shifts...not this 24+ hr. call crap. And, other than the occasional night shift, it looks like I've got a pretty easy 7.5 months ahead of me, until I graduate (not counting the month of studying that's coming up).

I think that remembering this will put me in a decent mood tomorrow. To help make sure I'm in a good mood, I think it's time to get to bed and get a decent night sleep.

Saturday call sucks!

Title pretty much says it all...what a waste of a day. When you have Saturday overnight call, you basically lose your whole weekend. You work all day saturday, get off Sunday, and then have to either sleep or be tired. The worst part is that I did basically nothing all day yesterday. There's just no reason for students to ever have to do overnight call on Saturday. The only reason some places make you do it is because that's how it's always been. Well, to me, that's just not a good enough reason. Mark my words...when I'm a resident, unless I'm absolutely not allowed to, I will be sending my students home early on nights and weekend. So many places seem to forget that we're students, who are paying to be there to learn medicine....not little scut monkey slaves to just stand around and wait for menial tasks to be thrown our way.

Fortunately though, as I'm less than 2 weeks away from being done 3rd year, I'll hopefully not have to do another Saturday call until I'm a resident! I do have call next Sunday, but at least you get Monday off. If I haven't already mentioned it, being a third year students sucks. If you're just about to start it, be prepared for lots of scut work, and lots of watching other people do things.

I sound bitter...I should get some rest!

A short update, and congrats!

First off, congrats to Trixie (and many other people out there) who recently started their first day of residency!  I imagine it to be surreal, the first time you see your name as "Dr." on the schedule, and are given med students.  I'm definitely looking forward to a year from now, when I can see for myself.  It seems like just yesterday that I was stressing about getting into med school, and then starting, and then getting through first year, then through step one, and so on.  Now, the end is less than a year away.  Since I'm in OB right now, it may be appropriate to say that if you got pregnant today, by the time you have your baby, I'll be done med school!

There's really not much exciting to report about rotation though.  Today was a pretty easy day, with only one short surgery, leaving me some time to study.  My guess is there's going to make up for it tomorrow, but I can only hope that I don't wind up with my new least favorite OB surgeon...the one who doesn't think a student is his assistant.

Things with my electives seem to be falling into place nicely and if I can make one more thing work out, there's a chance that I'll actually finish med school at the end of February!  My two rotations at Hopkins are just about all figured out and unless something crazy happens, they should be settled (which is probably the most exciting part of my week).  Just over 2 weeks left in OB, then I'll be studying like mad for the USMLE all over again (step 2, obviously).  I'm going to keep myself sane during that month long period by reminding myself that I'm a 4th year med student!!

Safari Reader

I just want to take a second to highlight a new feature in Apple's Safari browser, which I've quickly become a big fan....Safari Reader.  If you haven't yet downloaded Safari 5, you should do it right away (available from software update, under the apple menu).  It has other big features, such as finally enabling browser extensions, but Reader is my favorite.  The best way to explain Reader is to illustrate it.  In short, it turns this mess:

into this:

 

When you click the reader button, Safari strips out the all the ads, headers, and other garbage, and presents you with the article, without any other distractions.  CNN is actually not too awful, but some other sites are far worse.  Ads may be necessary, but I hate them, and I love that I can now have them instantly stripped from whatever I'm reading.  So, once again, thanks Apple, for making my life just a little more pleasant.  Now, if you could just drop AT&T....

getting closer

...to being done 3rd year, and it really can't come to soon!  I am developing a sever case of 3rd year senioritis, and I am beginning to get a little bitter.  I am totally over the 3rd year student role in the OR, particularly!  I hate standing around watching for hours on end, doing nearly nothing but some suctioning, retracting, and cutting suture.  Today, it took everything I had to keep my mouth shut, and it's a good thing that I only have 1 week in the OR left, because that's about all I can stand.  I'm gonna tell you the story, because I need to vent!

The surgeon I was with today does things a little differently.  Actually, lots of surgeons do things different, because they're surgeons, and I think they just like that they can do things however they want.  But, back on topic....this guy likes to have two Bovies and two suctions set up (one for him, one for the resident).  Since attendings rarely pick up a suction (they prefer to point to things they want me to suction), his is essentially mine.  So anyway, he was tying something off, I had my suction tip right next to his instruments, and he said, "suction."  Being a good little med student, I tried to suction.  He then barked at me, "not you!  Him!  He's my assistant, not you!"  Well excuse me, I didn't know that after suctioning for half the case, only the resident was allowed to suction the tiny blood vessel you cut!  At this point, I wanted to just cross my arms and not do another damn thing, since the resident is his assistant...not me.  It's sad that I actually still get a little excited when they let me suture...something that most doctors don't even want to be in the room for.  I still am not sure how I managed to keep my mouth shut through 3 months of similar stories in my surgery core.  I guess I'm gaining a new skill.  But, like I said, I'm very glad that there's only one week of it left!

Now, I need to eat something.  Preferably meat.  I really would like to gnaw on a steak!

1/3 done OB

As I think I've mentioned before, I decided to take OB/gyn in 2 weeks blocks, since that's how it's split up for us (two weeks each of OB, gyn, and clinic).  So, I'm now 1/3 of the way done, and it already seems to be going by quickly!  Unfortunately, I have a feeling that I've finished the part that I'm going to like the most.

So far, although I dislike the area, the rotation has been pretty good.  Some of the attending do a great job of teaching and really care about the students.  I also may have just gotten lucky so far, but I've liked all of my residents to this point, and some of them will also teach a decent amount.  This is definitely one of those places though that if you want to sit around and do nothing all day, you could get away with it, but if you ask, they'll let you do a lot and teach.

So far, I've seen a bunch of vaginal deliveries, and depending on the attending, they may let you catch the baby, suture up an episiomoty, or you may just watch.  There are also plenty c-sections every day to scrub into, and the experience in there is also attending dependent.  Typically, you'll just retract, suction, and cut suture, but a couple attendings have really done a good job explaining everything, pointing out relevant anatomy, and let me get my hand inside and feel around.  One, who really loves to teach (and is good at it), even asked the resident to switch places with me and let me do most of the closing.  Although I probably won't go into surgery at this point, it was very nice when he told me that if I didn't go into surgery, it would be a waste of talent!

Next is gyn, which is primarily surgery.  Unfortunately, it's probably just going to be more retracting and suctioning.  I'm really over the student role in surgery, and I wish they let us do more.  I've heard that some places, there are few residents and the students actually get to first assist a lot.  And, I love when I get to do that.  Sometimes I worry that I'm not going into surgery because I just didn't have a good enough experience, in the student role, to really fall in love with surgery like I thought I would.  But, if I really had gotten the chance to first assist once in a while and see what it's like to be a surgeon, I may have had different thoughts.   Because, when the one attending let me switch with the resident, I really didn't want to leave the OR.  But, I'm keeping an open mind, so we'll see how it goes in gyn.

The only thing I'm REALLY not looking forward to is clinic.  Mostly because the patients are almost entirely Spanish, and almost none of them speak English!  I do not have a problem with Spanish patients, and I'm all for diversity, but I do have a big problem with none of them speaking English!  It kind of pisses me off that they live here for years, are getting basically free care in the clinic, and then they can't even learn the language to communicate.  Fortunately for them, many of the residents are fluent in Spanish.  Actually, I don't think any of the residents natively speak English.  So, we'll see how that goes....at least it has the easiest hours.

Flushing pics

I decided to put up some pics of the hospital and the area.  Here's the hospital:

And here is one I took on the street, on my way to the metro.  I know, it's hard to believe that this is in the US (and outside of Chinatown), but this really is just another street in Flushing...

Happy Memorial Day!

To celebrate Memorial Day, the hospital has graciously given us the day off!  Unfortunately, being in Flushing, that leaves me with very little to do.  However, I did spend the weekend in the city with Lauren, which was a lot of fun!  On Saturday, we walked around Times Square, and got tickets to see Fela!  Very good true story, very good show (up for about 11 Tony awards).

After the show was over, Lauren's friend, who is the show's stage manager, got us backstage.  It was pretty neat to be backstage of a broadway show, but surprising how little room there was back there.  Afterwards, we went to dinner with the stage manager, learned a lot about the show, and saw Kelsey Grammer, who's starring in Le Cage next door, walk by.

Sunday, we spent most of the day hanging out on one of Lauren's friend's roof deck.  It was a beautiful day in the city, so a good time.  After some sushi (the food all weekend was much better than what I'm used to in Flushing), I headed back here, only to wait about 40 minutes for a bus to finally show up.  Had I known the bus was going to take so long, I would have just walked!  Have I mentioned that I don't like Flushing?

Thanks to Lauren for a good weekend!

Restaurants near me

These are the top results for restaurants near me, presented in the same order that Yelp provided them.  See any trends?

1. Southern Spice
2. Bownie Restaurant
3. Hahm Ji Bach
4. Sam Wok Gak
5. Kum Gang San Restaurant
6. Mapo
7. Main St. Imperial Taiwanese
8. Phobang
9. Tong Sam Gyup Goo Ee
10. A Fan Ti
11. Ah Rhee Soo
12. Happy Garden Restaurant

Going down to number 20 is much of the same.  Awesome!!  Or not....

OB....almost one week down

For my first two weeks, I'm working in the OB department, which means I spend much of the day either helping to cut out or catch babies. There is enough down time to study, but there is also plenty to do, and lots of opportunity to learn. Already, I've been in a few c-sections (enough that I don't particularly feel the desire to do anymore), seen a bunch of vaginal deliveries, and caught a couple babies. Those things are slippery!

So far, the rotation is going fairly well. The residents have been pretty cool so far, which can make or break a rotation. I've already had my first overnight call, last night, and the resident was awesome! Between delivering babies, which came extremely fast last night for some reason (apparently nobody wanted to be in labor for long), I spent time sticking my fingers into foam holes, learning how to judge cervix dilation just by feel. However, I was not able to try out my new skills, since after I was comfortable with it, the patients were muslims, and they don't allow males in the room. I am not particularly taken with this practice of their's, but there's nothing I can do about it. Much to the husband's disappointment, they did wind up having a male deliver their baby, since he happened to be the attending on-call. Overall, the residents were cool, the nurses were friendly, the deliveries were pretty exciting, and I even got some sleep...not too much to complain about.

Today, I'm post call, but I'm at a loss for what to do! I woke up at around noon, but I really don't have anywhere to go. Although the actual rotation is going well, I do not, at all, enjoy being in Flushing. There doesn't seem to be anything at all to do within walking distance, the restaurants are mostly Asian, and driving anywhere is a pain in the ass due to horrible drivers, traffic, and complete lack of parking. I probably could go into the city, but it's more of a hassle than it's worth since I'd either drive and not find parking, or have to take the subway, which takes far longer than it ought to. This weekend, I'm going into the city to hang out with Lauren (my sister who I suppose I've never mentioned), so that should break up the monotony. It's supposed to be a beautiful weekend, and I have a three day weekend, so looking forward to that!

How dilated are you?

I'm trying really hard to be positive

I have arrived safely in Flushing, NY.

Here's what I can come up with so far.
1. The place I'm staying is nice enough, and it's literally right around the corner from the hospital
2. This rotation is only going to be 6 weeks, and then I get to go back to MD!
3. I'm only about a 15 minute drive from the city

Although I've seen the hospital from the outside (and it is not promising at all), I will reserve judgement until I see the inside for myself.

4 down, 1 to go

Today was my last day of surgery, meaning I've now completed the two long 3 month cores, two of the short 6 week cores, and only have one 6 week core (ob/gyn) left!  It really is amazing how quickly time goes by in med school.  I'm not at all looking forward to 6 weeks in NY, particularly in Flushing, and particularly doing OB, but I know that shortly, it will be over too.  And then, it's only another few short months of electives before med school is over.

For those interested, here is my review of the St. Agnes surgery core:

Daily Schedule: I typically arrived sometime between 5:15 and 5:45, depending on the day.  On Mondays and Thursdays, you get in closer to 5:45, because there is no lecture and rounds begin at 6:30.  On Tu, Wed, and Fri, there is a 7:00 lecture, so rounds start at 6:00am (tuesday is M&M, wed is resident lecture, and friday is surg grand rounds).  About twice a week, there is a student lecture which typically follows one of the other morning lectures.  These lectures take priority over anything else.

After lecture, you usually go to the OR for the day, depending on how many cases there are.  There are days that you don't leave the OR until afternoon rounds (or you may miss rounds some days), and others that there are only 1 or 2 cases for the whole team, so you may not be in the OR at all.  OR takes priority over everything else but lecture.  So, if you're in the OR, you don't have to see consults or deal with floor scut, which is nice.  If you're not in the OR, you may be able to do some procedures around the hospital (sutures, I&D, pull drains, etc), you'll likely be asked to see a consult or two, and there is also actually plenty of free time to go to the library and study!  You also have to make sure and keep up with what's going on with your assigned patients (depending on the size of the list for the day, you'll probably have around 5 patients).

Surgery Teams: You spend one month each on blue, red, and gold team.  Blue team is primarily bariatric and some general.  You definitely get plenty laparascopic experience on this team, and the bariatric surgeons are some of the best you'll find.  However, the cases can get a little old after a while, and you'll probably be ready to move on by the end.  This is also the thoracic team, but there is really only one thoracic surgeon (the program director).  When you have surgeries with him, you better know about your patient!  Finally, there is a pretty renowned surgical oncologist on this team who does the HIPEC procedure, which you'll likely see at least once.  The surgeries can be pretty neat, but there is unfortunately no open heart here.  This team usually gets out the earliest at the end of the day.  Depending on who's on your team and what's going on, you'll probably be out between 4:30 - 6:00pm.

Gold team is primarily general surgery.  By the end, you'll probably feel like you could do a lap cholecystectomy, appendectomy, and cyst excisions on your own (although you never will, of course).  There is also a decent amount of open surgery, which can be pretty cool to see.  Lots of cancer colon resections.  Unfortunately, you also have to go to clinic twice a week (half day each) on gold service.  It's pretty standard clinic type stuff...some pre and post op underserved population patients.

Red team is primarily vascular surgery, with some plastic, urology, and hand cases.  You will primarily work with three surgeons, all with very interesting personalities.  They are mostly nice to students, very smart, and spend a decent amount of time teaching, but you are likely to hear some choice words in the OR, and may see some instruments thrown.  These are the longest cases, it's definitely the most demanding team, and you'll get out the latest (sometimes after 7pm).  The plastic surgeons are amongst the most polite in the hospital, but you don't get to do much in those surgeries (they suture themselves).

In the OR: In general, you don't really get to do all that much in the OR, because of the large number of resident, who want to do most everything.  You will, however, get in plenty of suture time...as long as you want to and are not an idiot.  Mostly, you spend time retracting, suctioning, watching, and often times closing at the end (the longer you're there and the more interested you appear, the more you do).  You may occasionally get to use the bovie, cut, tie, or staple something, but it's pretty rare.  You will probably never touch a laparascopic tool, other than the camera (which you drive pretty frequently).  Fortunately, you scrub into just about every case, so you're always somewhat involved.  Teaching in the OR is very attending dependent.  Some will pimp the hell out of you (rare), some teach, some don't acknowledge you at all (also rare).  You may get yelled at infrequently, but don't take it personally, especially on red team.  You also help get the patient ready, including moving around the bed, draping, putting in a foley, etc.    At the end of a surgery, you typically write the post-op note.  A few hours later, you should find the patient and write a night of service note.  Both of these are very fast and easy to do.

Call: Fortunately, this rotation has a pretty light call schedule.  Depending on how many people are in the rotation with you, you are on short call every 4-5 days, and long call every 12-15 (most likely 4, and 12).  On short call, you stay later than the rest of your team to help finish up whatever is going on.  This may mean taking a later surgery, seeing an extra consult, or something similar.  You usually are out around an hour or two after everyone else, but it could be more or less (rarely more).  Long call is overnight; you leave the next morning after rounds.  If there is morning lecture, you unfortunately have to stay for that too, but you don't have to stay for afternoon lecture.  You do not have any OR or floor responsibility (other than rounds) on post call days.  If you're short call on the weekends, you're really only there to round and should be out before noon (sometimes out before 9am).  Long call on weekends is still around 25 hours.

Residents/ Staff: It's really hit or miss, as with most places.  There are excellent residents, and there are some not-so-excellent residents.  The prelims are mostly foreign, and the categoricals (at least the new ones) are almost all US grads.  Unfortunately, the dept chair does not particularly care for caribbean grads, although all the students are from the caribbean!  The attendings are much the same...some fantastic, some not so much.  In general though, the staff is good.  There is plenty to learn, and plenty people willing to teach.  The scut work is present (as it is anywhere), but it's really not bad.  I was scutted much less in surgery here than I was in IM.  There is a good chance I'll return here for SICU rotation or a surgical sub-I.

I realize this is a lot, but it should cover just about everything.  Every surgical rotation is different, but this should give you some idea of what to expect.  It is tiring, and I'm glad to be done, but it's not as killer as some say...certainly not as bad as it was in years past before the 80 hour work week!  As I said, there is plenty time to study during the day too.

Exciting day!

Today is exciting because it is that last day that I have to wake up and come into surgery at St. Agnes! In addition, it is the last time that i will ever come into St. Agnes as a 3rd year medical student! I only have 6 weeks left until I can officially declare myself a 4th year, although i actually have less than a year left of med school. However, i am the lucky person who is the last long call of the rotation. I consider this a good thing, because it means that I'll be post call on the last day of the rotation. I'm not positive, but I have a feeling that they'll let everyone go early, so it may wind up not being that much of an advantage after all.

Before the end of the day today, I have a lot of studying to do, in preparation for the shelf exam on Sunday. I also have to find time to complete my case logs for the rotation, and take care of the stuff I'm actually supposed to be doing for the rotation. And finally, I've got an a/v fistula revision as my last official case of the rotation (something could come in overnight though, giving me more surgery). So, I guess I should stop procrastinating and get to it.


- Posted using BlogPress from my iPad

Location:S. Caton Ave, United States

OK, so here's the thing...

I have really meant to continue posting, most of the time.  I've considered quitting posting, but usually, I really have wanted to keep posting!  But, I just haven't had any time!  Surgery is crazy.  I know other bloggers have done it, but I'm not sure how.  In fact, the craziness of surgery is pretty much exactly what has made me come to a pretty big change in my thinking...I'm not going to go into surgery!

I really wanted to be the guy that loves surgery so much, they just want to be in the OR all the time, no matter what that might mean.  I wanted to be a hardcore surgeon.  But, I'm just not that guy.  Unfortunately (or fortunately, depending on how you look at it), I love to do lots of things, and those other things are difficult to do as a surgeon.  Already, as a student, I feel like I just wake up (way too early), go to work, get off late, come home, maybe watch a TV show, and then go to bed.  There's really not much time to do anything else.  And, I work less than any of the resident.  I probably do around 60-70 hrs a week, but there's no way that the residents are under the 80 hour work week.

So, instead of surgery, I will likely be going into emergency medicine, which is probably what I should have been looking at from the beginning.  I love riding the medic, and being an ER doc is really the best continuity with that.  I've also found that through the last 6 months in St. Agnes, I really love being in the ER...more so than the OR.  It's fast paced, shift work, your work does not come home with you, you don't follow patients, and there's no rounding!!  I haven't mentioned it since I haven't been blogging, but I despise rounding.  Really really despise rounding!  Yeah, there is a lot of BS that comes into the ER, but I've been finding that there's a lot of that in all of medicine.  However, you can get rid of that BS in the ER a lot faster than you can most anywhere else.  And, strengthening my decision to go into EM, there are also fellowships in EMS and trauma/critical care.  I could actually do the EM residency, plus two fellowships, in the same amount of time as general surgery residency!  I wanted to be a trauma surgeon anyway, so I can do a lot of the same stuff with a trauma fellowship, and I can also stay involved in EMS (as part of my job).  Seems pretty good all around.  Just to make sure i'm not crazy though, I'm doing two months of electives in EM.

Unfortunately, not much else new in my life to write about...just hasn't been a lot of time for it.  Today was my last Monday of surgery!  Since I have overnight call on Thursday, I get out early Friday morning, take the surgery shelf exam on Saturday, and then off to NY for OB/Gyn.  Not looking forward to that, but it's only 6 weeks, so I'll survive.  If I can survive IM, I can survive anything!

So, I'm going to really try hard to post much more often now.  Happy everyone?  Here is a picture showing my current level of sleep deprivation (and what it makes me do):

A day of yes

YES, I have been absent for a while
YES, I am sorry
And YES, I am coming back

Maybe tonight, maybe tomorrow, but updates are coming soon

Oh, and YES, I successfully placed my first central line today!
Check back for more updates soon, and sorry for the extended absence

Outside Hospital

If you've done any clinicals at any of AUC's clinical sites, this should give you a good laugh!

Happy Birthday to me!

Yes, today is my birthday! I am officially 28, and I feel a bit old. But, 28 means almost 29, and I figured long ago that I will be 29 when I become a doctor! Putting two and two together, only 1 more year until I'm a doctor! I just with I knew what I'd be doing and where I'd be doing it, but that will have to wait. Actually, less than a year before I find that out (slightly).

Since the last time I wrote, I've set up 3 electives. I finish 3rd year cores in June. July is dedicated to Step 2 studying. Then, for August, September, and October, I'll be doing emergency medicine, anesthesia, and radiholiday, in that order (1 month each). I'm pretty excited about all three of these rotations. Unfortunately, I still have to fit in neuro and family practice, two months that I AM NOT looking forward to. I'm also looking at the possibility of doing my electives at other hospitals in the area (the three I have so far are all at St. Agnes), so things could change. But, if nothing else, I've got things planned out through November. This makes me feel much more at ease; at least I'm headed towards graduation!

For now though, I've gotta change out of scrubs and get ready for birthday dinner at The Charthouse. Have I mentioned I love scrubs? Well...I do. That alone, could make surgery my favorite rotation.

funny because it's true

Fortunately, stuff like this does not happen every day and is probably the exception to the rule. But, sadly, with certain attendings, you wouldn't believe how accurate this is! Enjoy!

Even more congrats!!

Again, to my two favorite bloggers, who both did very well in the match, but also to everyone else that found out where they're going today! Of course the people who didn't do well likely keep quiet, but so far I've heard lots of very exciting news from people! Categorical surgery spots, pre matched anesthesiology, radiology, EM, and lots of first or second choices! AUC is behind you now, and I can't wait to be there this time next year!

Richard Dawkins: the greatest show on earth

Congrats!

To my two favorite bloggers and everyone else who matched today!!!


-- Post From My iPhone

end of the weekend post

Unfortunately, I did little exciting this weekend. I did finish registering for Step 2 though!! It's still a few months away (end of July), but I'm already a bit nervous for it. Fortunately, this will be the last time an exam really counts. Sure, I'll have to take step 3, but from what I hear, you only really need to pass that. However, to make up for a not-so-stellar step 1 score, I have to rock step 2. I did get a little hope from a fellow blogger though, that it is possible to do just that!

I also went into the hospital to assist with a below the knee amputation on Saturday! Yes, I went into the hospital on my day off, to help with a surgery. I either really love surgery, or am a very sick person who enjoys punishment. This is particularly true because the surgeon I scrubbed with very much enjoys asking me questions that I often cannot answer. Fortunately, he was impressed that I came in on my day off to follow through with my patient, so he didn't ask me anything. Either that, or he was just rushed to get out and didn't feel like wasting time. In any case, the surgery was very cool...probably the best of my time so far! Now, I have to go get food. As usual, I'm hungry!

a bunch of firsts

I wound up working long call (overnight) last night so that I could get off a little earlier on Thursday. Overall, it was exhausting, since I hadn't expected to be staying overnight and didn't really get enough sleep for it. But, it did turn out to be pretty worth while. First, I did my first arterial line. Later, I did my first solo lumbar puncture (and got it). And, just before I was preparing to leave this morning, we got two emergency appendectomies! They're kind of fast and not the most interesting surgery in the world, but they're interesting for the first (and second) time. And, I like any surgery where I at least get to suture at the end, and I did that at both of these. In between, I wrote a few progress notes. They're not the most exciting thing, but I still like having my notes actually included in the charts. Now though, it's time for bed! I'm beyond exhausted!

A breath of fresh air

It's only been 3 days, but so far, I love surgery!! I do not love morning rounds or the lectures which seem to happen a bit too often, but the surgery makes up for it, and there's definitely plenty of surgery. On the first day, I scrubbed in on my first surgery; today, i scrubbed in on three. When I'm in the OR, time just seems to fly by. I could have probably left today around 4, but i wound up there until around 7, because I felt like going into another surgery. I have to be at the hospital, and we've already finished rounding, before most people wake up, but it just doesn't bother me. It may eventually, and I typically really like my sleep, but it doesn't now.

I love the process of scrubbing in and getting sterile, talking to the patients before they go to sleep, watching (eventually making) the first incision, helping out with the surgery, and then watching the patient wake up, all repaired. That's the short version of it, but I love it all. Yes...this is what I"m supposed to be doing.

P.S. - Today, I graduated from suturing animal parts and cadavers to suturing real live people :)

Sucks to be on Medicare!

Unless congress can get their acts together and do something fast, Monday is going to be a very bad time to be a medicare patient! On Monday, a 21.2% cut in physician reimbursements will go into effect. There are already plenty doctors out there who don't take medicare or who are decreasing the number of patients they have on Medicare. But, if this goes into effect, it's going to be very bad. The AMA is already telling physicians how to help their patients find new doctors and physicians have already asked for handouts they can give to patients that they drop. When this happens, Medicare patients are going to be forced to go to clinics where it's hard to get appointments, you wait forever, and you get less attention. And please do not think that this is because doctors are greedy. Rather, it's because doctors are already not getting paid enough money, particularly in primary care (especially considering the quarter million dollars of debt you come out of med school with). If they have to take this cut, many will not be able to even remain profitable.

Situations like this are exactly why there is going to be an enormous shortage of primary care physicians in the future, and patient care is going to suffer for it. And, this is exactly why US healthcare could not ever survive with a nationalized government healthcare plan. The government already cannot manage the much smaller medicare program...the last thing they need it control over anything else! Once again, thank you Massachusetts!!

Update: so it looks as though this will wind up not really being a problem. Apparently the vote today had to be unanimous, so it didn't pass because one guy insisted on voting against it (there are some other things tucked in there, of course, that he didn't agree with). However, it will be able to have a real vote on Tuesday, where it will almost certainly pass, and things should carry on with little to no interruption. Good news for doctors, as well as people on COBRA or unemployment (other areas touched by this bill). Still, Washington really needs to get their collective heads out of their asses

One more day!!

Of internal medicine, that is! I have neurology clinic in the morning, followed by studying in the afternoon, before a 5-8PM lecture. Wasn't that sweet of them to schedule us an evening lecture the last day of the rotation, and the night before the shelf exam? Oh well...I'm determined not to be mad or frustrated anymore, since it's the last day!!

On Monday, I begin surgery...which I've been impatiently awaiting for years! My surgery student team was changed around a little so that now, I'll be with one person from AUC and two people who are in IM with me. Fortunately, they're both people I get along with well, so it should work out well. There are twelve people in my group, so we have overnight call every 12 days. Guess who was assigned overnight call on monday (the first day)!? Yes...me! I'm probably the only person who's actually excited to stay over and be kept awake in surgery though. Have I mentioned I'm excited? I just hope I'm still excited 3 months from now!

getting excited

In a week from Monday, I'll finally start my surgery core! After about a year of being VERY jealous of a certain blogger that my page links to, it's finally nearly my turn! I've already found out my team (blue team) and the people I'll be working with. So far, I've heard good things about my team of resident, and the other students I'll be with seem pretty decent too. Fortunately, none of them are interested in surgery, so hopefully they won't be fighting me for cases. It'll just make their lives easier if they don't! OK...just kidding....sort of! ;)

In the mean time, I only have one more week left of internal medicine. Although I have not enjoyed any part of my time in IM, it has gone by very quickly. It's double the length of my previous cores, but it seems about the same length. However, maybe it's that extra time which has made me so ready to move on. I did go out to dinner with a few of the other students last night though, and that was a good way to begin to end this rotation. We wound up at Joss Sushi Cafe in Baltimore, and it was every bit as wonderful as the Annapolis original. It's bigger and a bit nicer than the one in Annapolis, but the food is identical.

For today, I think I'm off to the firehouse...something I've been neglecting lately.

SNOW!!

So since I last wrote, we have had insane amounts of snow in Baltimore!! We had about two feet this past weekend, and then about another foot yesterday! Yesterday, I was one of the only cars in Baltimore that was out the entire time, while shuttling around hospital employees. I borrowed my dad's Denali, pushed through snow that really no one should have tried to drive through, and got over 30 employees to and from work, from 5AM to about 1:30 AM! I can tell you one thing for sure...if you are looking for a car that's good in the snow, that is it. More than once, I drove through well over a foot of snow, that no plow had thought to touch, and had snow drifts that were even deeper. I was exhausted by the time it was done, but it was pretty enjoyable. I would have rather slept in, but I know that I would be upset if I came into work and couldn't get home, or couldn't get any relief after being in the hospital overnight already! The people all seemed very appreciative, so it was worth it.

For the next couple weeks, I'm going to have an awful lot of studying to do, with the subject exam coming up immediately after I finish this rotation. Fortunately, I'll be in CCU / MAO for the next two weeks, so should give me much more time than I would have had on the floor. I still cannot wait to start surgery in just over 2 weeks! I'm planning on being chronically tired for 3 months, but I hope I like it as much as I think I will.

I know, i know, i know

I've been absent for a while, again, and I'm sorry!! I really do mean to post, and I'm not exactly sure why I haven't. I think it's because when I stop for a while, I feel like I have a lot to catch up on, and I'd rather just write about what I'm thinking in the moment, than what I was thinking many moments ago. And, the longer I procrastinate, the worst it gets. It's a vicious spiral!!

So what's going on this moment? Well...I've only got 1.5 more weeks left on the floor in IM!!!! That makes me extraordinarily happy. I am not going into psychiatry or peds, but there is a far better chance that I'll do those than go into anything requiring an IM residency. And that's unfortunate, because there are some interesting fellowships out there, I just could not stand doing 3 years of IM first. In fact, I couldn't even go into a specialty that required a one year IM prelim year. Maybe it's better at other hospitals, but from what I've seen at my current hospital, no way in hell. However, I am going to reserve my review of the rotation until I've actually finished it and gotten my grade...things can change in 3.5 weeks.

Speaking of 3.5 weeks, I really have to kick up the studying for the NBME subject exam, which I have to take immediately following the rotation. Very fortunately for me, I end this rotation with two weeks in the cardiac care unit (CCU) and clinics, both of which are far less time consuming than the floor, and will give me lots of time to study. Scheduling is the one thing that's actually worked out very well for me this rotation.

I'm beginning to get very jealous when I see the surgery students walking around every day. I cannot wait to do surgery next month! Come on, March!!

Hello again

I've been told that a lot of people read my blog (people who I never would have imagined), and I ought to update it, so I guess it's back to updating. I can't promise every day, but I'll definitely try to do better!

In any case, I have to honestly say that the last two weeks or so have not been horribly interesting for me. I'm currently a little over half way through my IM rotation. That part is very interesting (and exciting), but the rotation itself has not been amazing. I've pretty much always known that I wasn't going to go into IM, but this rotation has cemented that for me. It's boring, with a capital B-O-R-I-N-G. The day pretty much goes like this:

round on patients -> morning conference -> more rounding -> more rounding -> quick lunch -> noon conference -> even more rounding -> sometimes some more lectures. In between all that rounding and all those conferences is some time to write notes and do scut work.

Some people enjoy it, but it just does nothing for me. Even in my psych rotation, I felt that I was really involved in patient care and that I was helping people. I don't really feel that way at all in IM. I am jealous every day when I see the surgical students and hear about all the stuff they get to do. I haven't done my surgical rotation yet, but I have spent some time in the OR. And when I'm there, I never want to leave. When I'm rounding in IM, I mostly just wish I was somewhere else. I guess this is how medical students are supposed to know what they want to do for the rest of their lives...you wait until something clicks. Since I haven't done surgery yet (and by extension, no surgical subspecialties), I haven't had anything click yet. But, I have had things definitely not click!

P.S. - for those who know where I'm doing my rotation, I'm definitely not saying that it's bad at that particular hospital. The attendings and residents are mostly all very friendly and as helpful as possible. It's just a very busy hospital, so the interns don't always have the time to teach that they may at other places. But, there is plenty of opportunity to learn and see just about any disease process you care to see. If you're looking for somewhere to do IM, where I am is not a bad place to wind up.