bones, groans, and student loans

feel the burn...

2012-01-22T18:29:00.002-06:00

I've often wondered just how many miles we tread when we are on call. 30 hour shifts can be exhausting, especially when we are on the move every minute.

So, I wore a pedometer during my last call just out of curiosity.

And at the end of my run-of-the-mill, no sleep, bone-tired call, I glanced down to see my tally.

4 miles.

So, there you go ladies. Next time you are on call and running to the ER, running to a code, and running ragged, be confident in those steps!

Who knew? Call is actually decent exercise.

Perhaps now I don't have to feel as guilty about getting that midnight grilled cheese and fries from the cafeteria.

outliers...

2011-12-24T14:49:00.004-06:00

Because we work in the hospital non-stop, our views are skewed. We see and take care of the sickest patients you can imagine and sometimes it seems as if we are drowning in death. We forget about the hundreds of quick stays and visits and concentrate on those who always required an uphill battle, those that modern medicine just could not save. We see the extremes, the outliers, and often forget about those average Joes hiding out under the bell-shaped curve.

Because of this, we have adopted a few simple rules:

First of all, nice guys finish first. This would be great for the Chicago marathon, but not so much for the timeline of life. The nicer and sweeter a person is, the more likely they will have an incurable or debilitating disease. It's not uncommon to realize you really like a patient and then become angry because that most likely means they won't fare so well.

And secondly, assholes live forever.

It's true. In the hospital, life does not follow suit with the whole idea of karma. Bad things happen to good people and unfortunately we see this more often than others.

Perhaps this holiday season, we all should laugh a little heartier, have a couple more drinks, and let loose. Be just bad enough to not be the nicest person ever and maybe then we'll land ourselves some extra time.

Average is where it's at.

over the hill...

2011-11-30T20:15:00.007-06:00

Today, one of my clinic patients asked me casually if I had reached forty yet.
Forty what you ask?

40 years old.

He honestly believed I was almost 40 years old.
Sadly, he is more than a decade off.
I know he's 82 with hearing aids and glasses but every human with any brain cells knows to always shoot younger with women and never, never ask about weight or age.
After an awkward conversation, he was embarrassed and I am now thoroughly depressed.

Previous Christmas list: music, books, cooking utensils

Current Christmas list: Botox, weekly facials, high heeled pumps, and a personal trainer

sweepin' the clouds away...

2011-10-18T21:19:00.003-05:00

Whether or not they believe it to be true, at some point or another, residents and interns speak of their "cloud status." No, this is not the cyberspace sharing cloud, but rather the luck of those on call.
The intern or resident "on call" admits new patients to the hospital to the service they are currently covering, whether it be the MICU, Oncology, Pulmonary, Renal, etc.

Those with the "black cloud" status admit patients non-stop. They endorse busy call nights, rare sleep - basically the worst of the worst. Another key feature of the black clouds are their constant acquiring of rocks. "Rocks" are patients that stay in the hospital forever - well not forever, but longer than most. The average hospitalization ranges from 2 to 10 days. Rocks usually reside there for at least 3 weeks, some for months, and only a few for years.

Those who are "white clouds" have mostly nice call nights filled with zero or few admissions, restful sleep, and minimal annoying pages.

You would think that these terrible call nights would even out since all interns and residents do the same amount randomly throughout the year.
You would think.

However, this just does not seem to be the case. There are people who get killed every single call, admitting patients non-stop and if not admitting, tending to the very sick. And on the same token, there are people who breeze by most call nights, admitting a few here and there, taking time to nap and have dinner in the call room. I exaggerate of course - no one has it that easy - we are after all, residents in one of the toughest medicine programs in the country. But still, it seems the balance is always off and someone takes the brunt of the beating.

As an intern, I was a black cloud. I completed roughly 65 30-hour calls and only ONCE did I admit zero patients. And even then, this wonderful night occurred because there was a snowstorm outside, preventing travel to the hospital. I slept only a handful of times and there were dozens of sickies that needed the doctor in the wee hours of the night. Some months were worse than others, but overall, I was definitely on the black cloud side of things.

I've heard that this topic has actually been studied in residencies and that it was true - the balance was skewed. For whatever reason, some people have more work to do than others.
But someone told me a few months ago that this whole "black cloud, white cloud" thing was simply a matter of perception, or superstition if you will. If you think you're going to be busy, you will be and if you think you're invincible, maybe you are.

So, I adhered to his policy. I put my foot down and decided that I was no longer going to be a black cloud.

And with that, the craziest thing happened. I became a white cloud. No lie. As soon as second year started, along with my new mantra, my call nights have been....manageable. I will never use the word easy because some nights are so bad I want to "accidentally" stab myself in the eye, but averaged out, I've been free of thunderclouds and rain. It's only October and I have already had TWO no-hitter calls where I was able to sleep soundly to my iphone sound machine, snoozing to ocean waves.

So, if you are having bad luck, think again. No seriously, think again. Things may turn around for you - perhaps better weather is in your forecast.

mmm, mmm good...

2011-09-21T18:13:00.005-05:00

What is it about being sick that can make one so vulnerable? Illness can bring even the mightiest of soldiers to his knees. Your body is tired, you feel lousy, and let's be honest - you want to whine a little and let someone wait on you hand and foot and nurse you back to health.

I'm on call tonight, which means I've been here for 12 hours and I'll be here for 16 more. And I have a cold. No, it's not a hospital-admission-kind-of sickness, but it's just enough to make me wish for my sweet momma, some steaming hot Campbell's, and a cozy blanket. But alas, my mom's not here, no one cares that I'm not feeling 100%, and there's a lot of sickies worse off than me. So, I'm going to stick my kleenex in my pocket and suck it up and do my job, counting down the seconds until I can crawl into my bed tomorrow.

Despite centuries of valiant attempts, there is no cure for the common cold - except for a mom and bowl of chicken soup.

say cheese...

2011-09-20T15:36:00.003-05:00

I hesitate to put this out there, but I'm going to say it: there are mistakes in medicine.
Of course there are - we are humans taking care of humans - and with that comes mistakes.

Most are honest without the slightest bit of malice or harmful intent. Small mistakes that cause no problems for patients are very common. These are minor incidences and are often the result of oversight. It usually takes several mistakes from multiple steps in the system (often called the swiss-cheese model) to cause a major fumble, one that actually affects the patient and their outcome. These are the mistakes that are hard to swallow, no matter where you fell in the arrangement.

It's a difficult situation. We take care of many, many patients at once and we are working as hard as we can to deliver excellent patient care. But these things happen. Things fall through the cracks. Our healthcare system is broken and there aren't enough checks and balances in place to properly identify every little (or big) miscalculation or error.

I fall asleep each night wondering if what I've done that day was the right thing for my patients. I dream about my decisions and I often have nightmares about poor outcomes. I and most other residents obsess about our decisions to ensure we are doing everything humanly possible to bring our patients out of sickness and into good health. Oftentimes it feels as if we are carrying the world on our shoulders and it would only take a feather to cause a stumble.

Spider-Man said it best: "With great power, comes great responsibility." Mistakes happen, even in the most sincere, good-natured circumstances. And they will always happen because we are only human and always will be.
And that's just something we have to live with because, after all, this is the life we have chosen.

intern year, check...

2011-07-03T13:16:00.004-05:00

Just like that, in the blink of an eye, intern year is over.

It's unbelievable really. I've been sitting here typing then erasing, typing then erasing - it's too difficult to describe this past year in words and phrases. The growth of an intern is ridiculous. "The learning curve is steep" I was told and boy, that's the understatement of the century. The learning curve is not only steep, but the steepest incline you can imagine, perhaps almost perpendicular, straight to the top. I remember my first blurry days in the ICU, shaking with trepidation, thankful I had knowledgeable upper-level residents to ask about every order, every decision, every minute. My, how recent and at the same time long ago that seems. It's been a fast, yet incredibly slow year that has revolved around change, growth, and getting better every second. All the while, we were improving, advancing - and we've just been too busy to notice.

Now, here we are, one full year later. I am the upper-level. I am the resident. And as luck would have it, I'm back in the ICU, home of the sickest patients in the hospital and the state. Now that I have interns to supervise, I realize how new, pristine, and naive I seemed. They are newbies - full of ambition, questions, and fear and it's my job to guide them along like little ducklings while also allowing them their own autonomy.

While interns work grueling hours, residents have the most responsibility and I'm starting to see that this year is going to be hard in a different way than last. Growth will be set in a cleaner, softer light than last year, perfectly formulated to help me become a better physician. It's a beautiful transition really, one I have never understood until now.

Residency is a marathon, not a sprint - and the worst year is over.

So begins life as a resident.

counting sheep pages...

2011-03-23T01:20:00.007-05:00

It's the middle of the night. I am not yet delirious (that doesn't happen until sometime tomorrow afternoon) and I am about finished admitting a new patient.
AND I CAN'T SLEEP.
Perhaps it's the large 20 oz. cup of coffee I downed an hour ago or maybe it's because I am getting paged every other minute with silly, not-important-enough-for-middle-of-the-night-pages questions about urine output, flu shots, and headaches.

Thus, I am now sitting in the call room listening to good music and wishing this:

were actually this:

But alas, I take what I can get.
At least I have a place to lay my head, which is a lot more than I can say for some of the folks down in the ER tonight.

kick up your feet...

2011-03-17T18:25:00.006-05:00

Today is Match Day for all the fourth year medical students in the country. The much-anticipated, dramatized, most nausea-inducing, stressful day of medical school. My stomach flip-flopped just thinking about it today. It's been one year now since I was in their anxious, inexperienced shoes, awaiting my chance to finally change the world.

These days, my shoes are quite worn-in, in fact you could say they are dead-tired, exhausted, and wrung-out. They've trodden treacherous times with me throughout this first year of residency. They have stepped through bodily fluids in rooms with dying souls, walked through snow and ice to make it in to work, rested at a computer at every chance they could in the middle of many a night. They sat quietly while I delivered the news of cancer, death, and dying to concerned and anxious families. Even after all the miles we have marched, they always seem light when it seems they should feel heavy. They haven't given out on me yet - even after all the physical affliction I have thrust upon them. They've suffered a year of fast-paced medicine and they have helped me to oftentimes think on my feet and others to achieve the footwork it takes to makes things happen.

Yes, my shoes are quite worn-in, but with their faded look also comes a distinguished maturity one cannot buy off of a shelf.

You will never know what it's like to be an intern until you walk a mile in their shoes.

My advice to all those happy, shiny fourth-year medical students?

It's a marathon, not a sprint, so make sure you've got comfortable kicks.

Happy Match Day!

talk, schmalk...

2011-02-07T20:07:00.002-06:00

During rounds today, I noticed our vocabulary as physicians. We rarely use words that a lay person can follow. Our language is filled with medical terms, acronyms, and eponyms with the occasional sprinkling of common words.

As a medical student, I knew these words and forced myself to use them as often as possible. But there has been a change. As a physician, these words flow like water with not so much as a pause in between thoughts.

Being a doctor changes many things in life - the dialect being only the tip of the iceberg.

It's taken 6 months for me to realize I am immersed in all things medicine.....and wouldn't have it any other way.

craving hibernation...

2011-01-17T17:17:00.007-06:00

I keep hearing that January is the worst month of intern year - for many reasons.

First of all, it's the dead of winter. We go to work when it's dark and get home when it's dark. Our skin is painfully pale and our vitamin D levels non-existent. The winter blahs are in full force.

Secondly, now that we are halfway through intern year, our anxiety levels are actually increasing. This is because we realize we need to be better than we were four months prior and it often feels as if we haven't advanced much. It's scary to think that in six short months, we will no longer be interns. This means we will be working alone, with interns asking US for help.

Thirdly, the year has become less exciting. By now, we have rotated through most of the hospitals and general rotations and there is less "newness" to look forward to. We sort of know what's in store for the future and it doesn't seem as glamorous or intimidating as it once did.

And last but not least, we are exhausted. We feel depleted, frazzled, and spent. When I have an extra afternoon or day off, all I do is sleep. I'd rather sleep than shop - and that is not a statement I've ever made before.

It is for these reasons and more I realize why January is called the worst of intern year - it has a high burnout rate.

So, while the winter continues to chap my lips and chill my heart, I resolve to push through to warmer days - the time of sunlight, spring, and cessation of intern year.

auld lang syne...

2011-01-01T17:00:00.004-06:00

Here we are, another year come and gone. Today marks the halfway point of intern year. Halfway through Year One with only two more on the horizon. The first six months have come and gone in a flash and I am halfway surprised to say I enjoyed them all 90% of the time. It seems like only weeks ago when I was anxious about the new city, new friends, new job. I am happy to say they are all alive and well.

In the first half, I've come to love, hate, and adore the hospital all in one huge emotional heave.
I have now had enough time to know my strengths as an intern as well as acknowledge my weaker points (which I oftentimes feel are greater in number).
The idea of practicing in general internal medicine both overwhelms and inspires me because it, simply stated, is pretty damn difficult.
I now know what a sick person looks like, which seems an obvious statement but it is not, my friend, it is not.
I am delighted to receive a paycheck each month and know that I worked for every single dime.
My white coat is now quite worn-in - in fact, I am currently wearing my third of the year. As magical as they may seem, they never can put up much of a fight against coffee, blood, saliva and other juicy, delicious bodily fluids.
I have learned to be nice to nurses, because they can be your best friends or your worst enemies.
While my heart still flutters quite a bit when each Code Ten is called, I like making my way there and helping out as best I can.
I have learned that days off are well-deserved and few in number and any extra are easily the best gift any intern could receive.
While it sucks sometimes being the lowest animal on the food chain, it's nice sometimes too because it's always acceptable to ask for help.
If my counting is correct, I have personally admitted and sent home around 60 patients since intern year has begun and taken care of who knows how many more in addition.

It's been a big year.

2011 ushers in a new level of confidence, certain feelings of accomplishment....and a smidgeon of nervousness that, well let's just be honest, will probably never go away as long as there is the potential to impact a person's life span.

Yes, another year has come and gone. I feel smarter and more grown-up, although many of my patients still comment that I look sixteen, which brings me to another very important learning point of 2010. When patients ask your age, never reply with a number under 30. Thirty is more "adult" and it will help calm your patient's fears of being treated by a Doogie Howser preteen. Sure, it's slightly false by only a mere three years, but a little white lie never hurt anyone - and after all, it's for their health, right?

Happy New Year!

it's beginning to look a lot like christmas...

2010-11-28T15:44:00.005-06:00

I was able to sleep for an hour while on call the other night. I thought I'd snap a few photos in the call room since sleeping in there is a rare occurrence. Note the socks.

battleground...

2010-11-20T14:30:00.005-06:00

There are many battles in medicine. Hospital vs. clinic, doctors vs. insurance companies, surgery vs. medicine, primary care vs. subspecialites, the list is endless. Lately, I feel like it's been ME vs. TIME. To be a good doctor, it takes time and it seems like time is what we have the least of.
I'm currently working at the hospital on the general medicine wards and I often take care of difficult patients. "Difficult" may mean their medical problems are hard to manage OR something else, such as high-maintenance families or no where to go when it's time for discharge. All of these issues are dicey and simply take time to sort out. I have found that if I spend more time in a patient's room explaining their diagnoses and our plans for treatment, they and their families are less likely to be unhappy with their care and thus, make my job easier. If I put more time in with them at the beginning gaining their trust, I can make my future days with them more manageable.

But, it's just not that simple.

Residents are constantly strapped for time, which is frustrating because to our patients it seems we are uncaring and unavailable. What do they think I am doing all day, drinking margaritas while I watch Days of Our Lives in the call room? Hell no, I am trying to launch orders, churn out notes, make follow-up appointments, dictate hospital summaries, ensure good transitions of care, all the while trying to find the time to teach medical students as well as attend our daily conferences. There is just not enough time in the day to do every little thing and that forces us to choose the most important items on our list. Sure, it would be best for my patients for me to spend hours speaking with them, educating them of their diseases, but it's simply not a realistic possibility. I do what I can to help them and then and at some point, I have to call it. I have to pack it up and go home, leaving some boxes unchecked, which is no easy feat for a Type A personality. There comes a point where as an intern, I have to protect myself and I must go home.
And on my way out, I raise my white flag and surrender to 'ol Father Time. He has beat me yet again and I hate to lose.
But our battle is not over - I will win ...eventually.

hey doc, my chest hurts...

2010-11-08T15:10:00.003-06:00

Empathy is an expected trait of physicians and yet, a trait I sometimes find myself without. Sure, it's easy to empathize with the girl my age who had a car accident or the little old man who was recently diagnosed with colon cancer. It's easy to relate to people who have lost a family member or experienced misfortune through no fault of their own. But, it's just too hard sometimes to understand and try to relate to people that are polar opposites of myself. I'm not talking about race, religion, or social class here - I'm talking about decisions. And a lot of people make poor decisions in life, especially when it comes to their health despite being told several hundred times otherwise. This makes me seem callous and I often feel bad about it, but I simply cannot empathize with the folks who don't take their own lives or those of their loved ones seriously. It's one thing to start habits that are terrible for your body, but it's a completely different ballgame when these people never have the urge to quit. These are the times when my empathy level is near absent. Instead of speaking to them with a soft and endearing voice, I want to bellow at them loud enough to be heard two floors down.
HEY GENIUS, PERHAPS YOUR FIFTH HEART ATTACK IS DUE TO THE FACT THAT YOU CONSTANTLY SNORT COCAINE!!!
I've been thinking about how I can try to relate to these patients better. My goal this month is to take an interest in their habits, try to identify why and when they started, and have a serious conversation about what kinds of problems are in their future if they continue.
Nine-point-five times out of ten, this won't change them, but it's worth a shot. If I can relate to one person this month and steer them towards the road to recovery, then perhaps I can help myself in the process to become a better physician.

there is rest for the weary...

2010-10-30T10:52:00.001-05:00

As an intern, we are given grueling schedules - 12 hour days, constantly on the move, and little down time. However, for two months of the year, we are granted ambulatory rotations. This means that two months out of the year have no overnight stays, no weekends spent working, and a full week of vacation. And this my friend, is my October. I have slept more this month than I have in a very long time and it has been delightful. I went hiking, caught a movie, cooked, and spent time with friends- enjoying my time as a normal civilian. I write this as I lay on the beach - vacation week is under way.
Crunching numbers the other day, I figured out that for the month of October, I have been making 43 dollars an hour after taxes. This includes a full week of paid vacation and (I can't emphasize this enough) no overnight calls. I think 43 dollars an hour is quite impressive.
Now, let's compare October to the other, more common months of the year. When you sit down and do the math, it comes out roughly to EIGHT dollars an hour. EIGHT. I have put in now eight years of post-high school education to make eight dollars an hour as well as rack up over $180,000 in student loans.
Sadly, this is one of the many things in life that I simply cannot control. I can't spend my time worrying about money. There is plenty of sun to soak up and drinks to consume. It's my very first paid vacation and I won't waste it thinking about the perils of intern year, although I think the word "perils" is slightly too dramatic.
When I think about it, intern year hasn't been intolerable - in fact, sometimes I've even had fun. Of course, this is easy for me to write sitting under an umbrella on a beach rather than being equally busy as I am tired around midnight at the hospital. We'll see how I feel after the cloud of October lifts and I return to the grind November 1st.

reconciliation...

2010-10-03T16:25:00.004-05:00

This might be a weird statement, but I love the hospital in the middle of the night. I mean, don't get me wrong, I'd rather be in my bed at 3 AM rather than walking the dimly lit halls on the ninth floor, but since it's my job to be there, I may as well like it. The hospital during the daytime is a circus - blazing with an endless array of characters and acts. At night, it reminds me more of the ocean, calm and steady with the occasional hurricane.
At nighttime, it is usually fairly quiet. There are still IV pumps that beep in patients' rooms and the occasional television blaring on full volume, but for the most part it's hushed. There are no visitors asking for directions, no family members asking to speak to "the doctor," and no hustle and bustle of the 8 to 5 crowd. It's nice - serene even.
I have incorporated a routine into my nights at the hospital. I try to escape somewhere in the middle of the night and have a little "me" time. This me time might include resting my eyes for a few minutes, catching up on a few emails, or making myself a fresh cup of coffee. I find my place where no one else is and I breathe deeply, appreciating the peace the nighttime hospital has to offer. I don't always feel I have the time for me time, but I do it anyway. It's my tactic to keep from losing my last shred of sanity or welling with tears from the fact that I am simply physically and mentally exhausted. Needless to say, my me time has become very important to me.
We've had our share of hard times - the hospital and I - but this is our agreement, our harmony. I figure that since it takes so much out of me during each day, it can give me back some serenity at night.

on the uphill climb...

2010-08-18T19:16:00.004-05:00

About two months into residency and loving it. No big complaints, just trying to adjust to this new life. It's been a little unnerving being "the doctor" when all I have ever been in life is "the student". There are many things I never realized as a student that the residents juggle and take care of. I constantly carry around my to-do list for each patient and there is always another box to check or new issue to investigate. I once envied all the residents who were constantly paged - I wanted to be important enough to be paged with serious patient questions. I now wonder why I ever thought being paged a million times a day seemed glamorous.
I woke up at 3:30 yesterday - 3:30. That was officially the earliest I have ever woken up to head to work. Juggling many patients takes time and sometimes it cuts into sleep, but you have to do what needs to be done. No one is taking care of them except for you, so you can't depend on someone else to do your job and you must make sure that you've covered all the bases.
In addition to rounding, changing orders and plans on our patients each day, we also are expected to attend conferences throughout the day as well. They are usually very informative, but I often sit through them thinking about my to-do checklist (this patient needs this medicine added, this lady needs a CT scan, what the heck is wrong with this guy, etc). We have also started working in clinic as well, which is cool because I have my very own patients not in the hospital setting. But again, that is another thing to do on my already super-long to-do list.

As you can tell, things are busy, busy, busy. Being an internist can be very challenging because you are taking care of the entire patient, which means you must know about every problem and issue that arises. At this point, I am trying to learn as much as I can at this super-sonic speed and trying not miss anything important that could be detrimental to my patients' care. I realize it's the uphill climb and that the worst of this year is yet to come, but I can already tell it's going to be one of those years that I'll look back on and love.

intense intensive care...

2010-07-23T15:49:00.004-05:00

4 weeks in and I'm exhausted. I am working in the ICU, where the patients aren't just sick, they are very sick - many of them are dying. Whoever named it the INTENSIVE care unit knew exactly what they were doing. Overall though, we are surviving and learning something new every single minute. It's been difficult being in a new hospital and learning a new system, though slowly but surely, we are getting the hang of things. As an intern, I am one of the new kids in town, so we are known as the inexperienced ones and it's understood that we will have a gazillion questions about what to do next. The hospital is huge (it extends for many blocks) and I basically only know how to get from my car to the building I work in each day. My white coat is no longer pristine and starch-white, it now has some character with a more worn-in look.

I have enjoyed the connections I've made with family members of my patients. I've been a part of many very emotional family moments and prayers and have enjoyed viewing the solidarity of family and friends in times of uncertainty. I've had many patients pass away this month and telling family members about deaths has not been easy. I've also had a few patients live that we all thought wouldn't. The ICU is a minute-by-minute kind of place and if I've learned anything, it's that you never know what will happen next.
By nature, I am a planner. I like to know what will happen when and where and I like to be overall informed of the workings of the day, which of course is the exact opposite of a physician's life in a hospital. At any second of my day on call, I can be called about a new patient arriving that could range anywhere from stable to coding to dying. So, when I am on call, I try to relax, take a deep breath and know that I do not know what will come in next, but I will do my best when they arrive.

So, big picture: It's really fun/freaking exhausting being a doctor.

surrealism...

2010-06-24T16:22:00.004-05:00

Today was very surreal. In television terms, I'd describe it best as a strange deja vu-ish episode of LOST with a hint of The Twilight Zone and commercial breaks from Nickelodeon.

It was just weird. People were referring to me as "Doctor" and I signed orders without being totally sure if what I was doing was the right thing. A strange sensation kept recurring on my knees and every time I looked down, I realized it was my white coat that was brushing against them. My white coat is already heavy-laden with pamphlets, papers, ID badges (for what I am unsure of) and a length I am just not comfortable with yet. I was told to go home early and sleep since I will be on call tomorrow and "definitely won't get any sleep then." I was paged with questions I wasn't sure how to answer and I realized that while the student and I were similar in age, our responsibilities are quite different.
Overall, while not devoid of anxiety, it was a painless first day.

I've heard intern year compared to a roller coaster: every year, 60 people get on and every year, 60 people get off. There are many who have come before me and there will be many after me. It is survivable and it's important for me to remember that. Day 1 down, 364 more to go.
Enter Intern Year.

head first...

2010-06-16T21:42:00.003-05:00

Orientation is under way and residency will soon begin. My new title and I are swarmed with new faces in this new town that boasts both charm and size. We spent the past few days reviewing codes and later in the week there is a picnic scheduled for our intern class. There are 40 of us, hailing from all across the country and from varied walks of life I assume. By the fate of the match, we all ended up here in this Internal Medicine program together and while these next three years will be trying and difficult, I am certain they will be some of our best.

It's weird to say - I thought I would not want this vacation to end, but it's the complete opposite. I am ready. Definitely not PREPARED, but ready. Ready to work on a schedule, ready to make a paycheck, ready to become a sleep-deprived doctor. I am scheduled to begin with a month in the MICU. Who wants to just get their feet wet? I'm diving in and pretty excited about it.

comma m.d.

2010-05-24T10:00:00.003-05:00

Throughout our medical school years, we have been told that every physician has his or her own "style", or way of practicing their profession. Not everyone interacts with patients the same way and no two people can have the same bedside manner. So, we've watched doctors throughout our lives and we have taken note of who we'd like to emulate and closely monitored their introductions, goodbyes, exams, movements, stances, anything that gives us a hint of how to be more like them and less like the awkward student standing next to them. Of course, in this time we have also watched those that have failed at delivering bad news well, forgotten the importance of a touch, or talk to patients in jargons way above their laymen heads. These physicians, I have come to find, are just as important to see as those that we hail as the best because they have shown us the other side, the shortcomings of medicine, the countless lists of "what NOT to do."

We have received our long-awaited long white coats. They are decorated with our names and specialties and are starched with mile-long sleeves and fancy buttons. We have received our diplomas that state "doctor of medicine".
We graduated from medical school.
We all look the part. No more standing behind the "real" doctors, the umbrella of "student" is gone and residency will soon begin.

But after all this time, I realize that our coats are mere fabric and our diplomas only paper. After four long years, it is us that has changed and with our new titles we will begin practicing our own styles of medicine with our own flair using the compilation of experiences we have long observed. I hope we will all remember what we strive to emulate because before we know it, students will be watching us, wondering how their styles will compare to our own.

So begins our lives as medical doctors.

cap and gown...

2010-05-17T18:29:00.004-05:00

In a few days, we will graduate from medical school, which is you know, sort of a Big Deal. I keep having nightmare-ish thoughts that at any minute, the academic affairs office is going to call and tell me that something has happened and I won't be able to graduate. Of course, that's worst case scenario, but since it isn't completely out of the realm of possibility, I still consider it a maybe occurrence. I am also slightly anxious about walking up metal steps and across a stage in front of 3,000 people.

That being said, I am still nowhere near as nervous as I was Match Day. I'm pretty sure Match Day and its hype will continue to dominate medical school memories everywhere, while graduation day will be but a mere happy credit rolling by.

n a few days, we will graduate medical school. Yikes!

the big move...

2010-05-06T22:23:00.004-05:00

To be honest, I haven't thought much about school lately. With graduation only weeks away, I have been busy relishing in freedom while I can - and not meditating on what looms ahead. I spent the entire day packing and loading up my moving van without a thought of my call schedule, fellow interns, hospital layout, or knowledge base. But as I sit here on the floor of my now-empty room in the first silence of the day, I can hear my thoughts loud and clear, echoing away in my head: Soon I'll be a doctor. Soon I'll need to know things and soon these decisions will be on my shoulders. What if I fail?

But as I ponder, my faint heartbeat reminds me that I am only human and my best is also only human. It's all I can do and I will do it - because this is it. This is the time we've been waiting for - there's no opportunity to go back and learn more or prepare extra. This is it - and it all starts with the move. Let's jump in and see what happens.

wish I could be as brave as this young man...

2010-04-09T18:45:00.000-05:00

three days...

2010-03-28T20:48:00.003-05:00

In three days, my month in the MICU will be over. In three days, I will have nothing more to do for the entire school year. I only have three more days of work until I graduate in May.

Three days and I am home free.

matched...

2010-03-22T19:43:00.005-05:00

Big, bad, scary Match Day is now over and let me tell you - it lived up to its hype. I can't remember the last time I was as nervous as I was that day - sitting in my seat next to all my family, waiting for my name to be called to find out in front of 700 people where I will complete residency training. I had two mimosas with breakfast to calm my nerves and then took a teeny, tiny bathroom break mid-event - even though our names were called at random and I very well could have missed my own. But finally, after about 80 people, my name was called and...well, I'd love to give a play-by-play, but sadly it is all just a blur now. The important thing is that I matched - and at a program I was very, very happy to read aloud into the microphone.

Overall, my class of 115 had a very successful match. We matched people from California to New York to Florida - and many states in between. While I was trembling in my seat from sheer shock of the reality that is Match Day itself, it was quite fun to watch my classmates and friends announce their futures with confidence and delight. I was a wound-up ball of emotion and when I finally found out my fate, I wasn't sure whether to laugh, cry, or squeal with joy.

In a few short months, I will be graduating medical school and moving to a new place to begin residency. Most of my friends will also move away to delve into their careers as well. It will be a terrifying yet exciting time and I will countdown the days until its arrival.

But until then, I will continue to enjoy fourth year and hope I don't forget everything I've learned thus far in medical school - because Lord knows I will need that knowledge come July 1st.

marching on...

2010-03-10T22:31:00.005-06:00

This month, I am working in the MICU - the Medicine Intensive Care Unit. The ICU is where the sickest patients in the hospital are kept so that they can be closely monitored at every minute. This unit is filled with ventilators, breathing tubes, visiting hours and wires galore. The ICU has always intimated me - I have never quite understood ventilators and I am acutely aware that patients can go downhill at any moment. I was reminded of this in the first five minutes in the ICU on March 1st - I walked in reporting to duty, and a patient was coding. This is an occasional happening in any hospital, but a frequent occurrence in the ICU because the patients are just that sick. And I felt sick knowing they were sick and it was sickening that I knew minimal about how to help them feel better.

But, to my suprise, I have loved the ICU, or "the unit" as we affectionately call it. I am starting to understand ventilators and pressors and shock and organ failure. Procedures are often needed in the unit and us M4's are getting first pick at spinal taps and central lines. As weird as it sounds to say, it's actually been fun working each day with the sickest of sick, jumping for joy at the slighest inch of improvement because that inch could mean a foot in the hope of recovery.

Of course, not all patients have improvement and some have little or no hope at all for recovery and this is hard to see, as it always is. I have been impressed with how professionally and systematically each patient is handled. I am becoming less and less intimidated by the unit - it's becoming less of an anxiety-inducer and more of a comfort in caring for others - a wonderful month to mark the end of my medical school career.

time and time again...

2010-02-23T22:06:00.003-06:00

The past several years have operated basically on a timeline. We've lived through our calendars, day to day, month to month, exhaling after each important deadline. There are the main milestone dates, such as the day of medical school interview, the day you receive your acceptance letter, the day you start medical school, test days 1-150, and the dates of Step 1 and 2. Fast approaching is the day that puts all prior days to shame, the day that all previous dates and events were working towards diligently. Match Day. March 18th will be a pivotal milestone in the timeline that is our medical careers. This is the date that really matters in the long run - we have always been working to get the best grades, make the best board scores, receive the best comments - to ultimately end up in a respected and desired residency.

It's sort of funny really. We act as if Match Day is the end, but in reality it is only the middle, a mere stepping stone. Just as our lives have been operating on a timeline before, they will continue to do so after March 18th. There will be future dates to come - first day as an M.D., first day of residency, first night on call, first code blue as a doctor, first mistake in medicine. There will still be stress, just as there always has been, but with a serious, more sleep-deprived tone.

After four years I'm just starting to zone out and realize that Match Day isn't the most important day of my life and there will be many, many more dates I will mark on my calendar in the future.

Furthermore, this timeline isn't just a timeline, it's not a simple code of my career nor a to-do list to be a physician - it's my life - and each "milestone" carries with it memories, snapshots, and glimpses into my journey.

I thought those days were over...

2010-02-18T16:59:00.006-06:00

If you sit down and compare the two, the process of getting into a medical residency is basically sorority or fraternity rush. The plot lines are similar: you are looking for your best fit to spend the next few years of your life, and they are looking to fill their group with the most qualified candidates. And while the details of each are different, the process is quite similar.
First, you put in your application - let everyone know you are looking around. If they like you, you are selected to come for an interview. Everyone is super-nice and accommodating and they all are sure to always put their best face forward. At each stop, you run into people that tell you great things about the program and use phrases such as "you would really excel here" and "our camaraderie is like no other." Interviews can be both stressful and fun and applicants make friends with other interviewers along the way.

After interviews are over, each applicant makes his or her list of preferred programs. They rank their favorite first and so forth. Each program meets as well during their own "bid session" and makes their prospective rank lists. Then, the lists go into a magic computer and, lo and behold, it spits out the match list. The match list is revealed on the aptly-named Match Day, thus completing the process.

One aspect that definitely crosses both sides of rush and residency recruitment is the politics. As I am sure we can all attest, people get places in life by "who they know, not by what they know." Now to be absolutely fair, residency recruitment is MUCH more about aptitude than connections but let's be honest - connections never hurt anyone. It's much nicer to throw out big names during an interview rather than talk about your measly love of medicine. And it's a plus to have someone on the program's side who knows you personally and can vouch for your character.

It is for these reasons and many more that I have continually likened my residency recruitment experience to sorority rush. In essence, Match Day is actually Bid Day - complete with a new group of friends, white coat/jersey stating your affiliation, and a binding contract for the next several years that begins with a period known as the internship/pledgeship.

Okay, not exactly the same, but pretty damn close, right?

over the hill mountain...

2010-01-20T22:56:00.010-06:00

When asked why Geriatrics is a preferred field of medicine, the answer always comes easy: the patients. For the most part, they are sweet, loving, and wise people that have had a lifetime making memories that they usually want to share with any ears that will listen. (While not always comprehensible, their stories can be quite entertaining.) One thing in particular I love about these people is the dialect. Sugary-sweet phrases such as "mornin' doc," "bless his heart" and "Lordy, lordy" ring much nicer in my ears than the usual "you're too young to be my doctor" or the ever-so-kind "get out of my room."

Yep, older people are good souls. They trust their doctors, they appreciate their medical care, and they most definitely know the value of hard work.

I say all this to speak about one patient in particular I've taken care of recently. She is the oldest patient I've ever seen before and furthermore the oldest person I've ever met. At the ripe age of 106, she takes no medicines, is pretty functional, very polite and she just may have been the sweetest lady I've ever met.

Which leads to my next point: geriatric patients can help you to forget about age and remind you to always stay young at heart.

anticipation...

2010-01-12T19:42:00.004-06:00

With interviews winding to a close (only one more to go!), this whole match process is becoming less of an old wives' tale and more of a reality. For those not familiar, "Match Day" is the day when all fourth year medical students find out where they will do their residencies. Oh, and did I mention they find out in front of several hundred of their closest friends? It's pretty scary if you think about it, which is why I have tried NOT to think about it the past four years. I haven't ever even attended Match Day because, if I did, it would mean that it really does exist. In fact, simply talking about it brings about a cold sweat. But I'm starting to realize that sadly, despite my denial, the day is still approaching and in far too fast a manner.

In two short months, we will all know where we will spend the next 3-5 years of our lives.

And while we can lose sleep, discuss at length, fervently pray, and obsess about it all we want, no one will know for sure until they open that little white envelope. Our futures will remain but a question mark until that glorious/scary/dreaded/anticipated day.

R.I.P.

2010-01-06T22:22:00.005-06:00

My laptop decided to end 2009 with a bang - the "bang" being death. When I saw that blue death-is-coming screen in all its "physical memory dump" lingo and dos-like fonts, I knew the time had come to say goodbye.

I purchased her at the beginning of medical school and we began our journey together. She was there for me through countless powerpoints, internet surfing, and music downloading. She was a loyal and faithful friend who gave her all to the betterment of my education. She was cumbersome in her 17 inches, but always very open and easy to read. Compatible in almost every way, she only became sluggish in hard times, as we all do. I will miss her, but I know she deserves rest now after these three years of hard labor I have assaulted upon her.

It hasn't been decided just how to lay her to rest yet - there is still an autopsy to come to extract some vital parts. Be assured she will be given a proper farewell because she is something that can never be replaced...although this 10 inch notebook is doing a pretty good job so far...

new year, new career, new fear

2010-01-01T17:31:00.003-06:00

It's 2010 - the year we have been long awaiting. For the past four years, "May 2010" has loomed in our heads, allowing us to imagine the day that is to come in the future - the day we receive our medical degrees. 2010 has crossed my mind at least once each and every day since I received my acceptance letter into medical school. It seemed surreal to me at the time, this future date that would mark the beginning of my professional life. I kept thinking, "In 2010, I will be a doctor."

Well, holy crap. It's 2010 and all I keep thinking is "I'm going to be a doctor???"

adventures awaiting...

2009-12-01T17:35:00.003-06:00

I am officially free of clinical duties or any type of school-related work until January 1st. That's right - a month completely off. And speaking of good fortune, I also will have April, May, and June off as well.

It's nice to be a fourth year.

learning to travel light...

2009-11-24T16:09:00.007-06:00

We basically finished up our anesthesia rotation today, just in time to have a wonderful turkey holiday. Furthermore, I am free of any clinical duties in December which leaves me ample room to travel for interviews. I'll be visiting numerous big cities for interviews and throwing in 2 more just because they're fun.

What am I thankful for this Thanksgiving? cheap airfare

code blue...

2009-11-23T18:25:00.003-06:00

we've always dreamed of saving
the pagers beep, the overhead voice calls
we run, we run
no one ever told me.

electric current through his heart
broken ribs, bags, needles
the orders create a melodious hymn
everyone panting, with frantic and knowing eyes
thankful they have an abundance of breaths left.

thankful they aren't HIM
the inanimate nucleus of the hospital room
this disheveled, beautiful, lifeless bulk of mass
he is extinct
the time is called
he was younger than me.

we all walk out
sweating, setting this aside in our minds
back to work now
not a moment for grief
there is too much more to do.

I want to remember this
but not more than I hope to forget
it hurts.
no one ever told me
when are we supposed to mourn?

breathe in, breathe out...

2009-11-10T20:42:00.003-06:00

This month I am rotating on Anesthesia. Why would I, someone who is pursuing Internal Medicine, rotate through Anesthesia? Well, all seniors must do some sort of surgical month their last year and (thank the good Lord) Anesthesia counts as surgery. Most of our time is spent in the operating room starting IV's and giving the medicines that cause patients to drift off into a nice, peaceful sleep so that we can all see them naked and strap them down and cut them open - and not necessarily in that order. Now to be honest, I'm not much of a "procedure person" a.k.a. I've failed on the first try for many procedures over the past few years - I just don't have the knack for it that others do. But, yesterday was not a typical day.
They asked me to intubate the patient and I did - perfectly, with no hesitance and no flaws. I picked up that small plastic tube and slid it down into the patient's throat so that we could help him breathe during his surgery. I was elated - I could have shouted from the rooftops my excitement about (finally!) a successful, clean procedure.

Not surprisingly, no one in the OR really cared or noticed that I intubated successfully on my first attempt ever - although I'm sure my patient would have been appreciative had he not been off in La La land dreaming about ponies, unicorns, and marshmallow clouds.
I was excited and I guess that's all that matters.

hello my name is...

2009-11-08T19:21:00.006-06:00

November is here and with it has arrived the long-anticipated Interview Season. Lots of handshakes and hellos, strengths and weaknesses, "tell me about yourself," - the whole bit. I feel like an imposter discarding my fun, comfortable clothes for a stuffy suit and matching black leather portfolio. I wonder how any applicant stands out when we all can appear so similiar on paper. This is it - the time when we can view other programs with a intuitive eye and honestly ask ourselves if we could belong there. There are decisions to be made and only time will tell where we will all end up. It will very, very interesting to see how things turn out.

just call me typhoid mary...

2009-10-21T08:53:00.005-05:00

In studies concerning hospital infection control, The American Medical Association and public health officials think they have found a common culprit that is capable of carrying disease from one patient to another. This "carrier" has easy access to every room of the hospital and is constantly on the move. Who is this nasty vector of widespread disease?
Why, it's none other than the doctor's white coat.

Ironic isn't it? Those that come to heal are actually coming to....bring you some multi-drug resistant organism waiting to set up shop in your hospital room.
There are many new opinions that believe the white coat is doing much more danger than good. Many believe white coats should be abandoned altogether and in fact, Britian has already banned white coats as well as neckties, hand/wrist jewelry and long fingernails in the healthcare setting. As with all controversial ideas, there is a fair amount of opposition to this idea that physicians should leave their white coats behind. Some people feel evidence is lacking and that the white coat is part of their persona, their makeup, and they wouldn't feel as much of a physician without it.
Now, maybe this is selfish, but I am going to be ecstatic to receive my long white coat in May. Mostly because I feel I've earned it but also because I loathe the dreaded short white coat that has branded me as inadequate these past 4 years.

If you think about it, the white coat is a piece of power. People like to wear it because it shouts to everyone who you are without you having to say a word. That being said, white coats are a dime a dozen these days in the hospital, with everyone from pharmacists to phelbotomists to nurses to social workers having one.
So, what is the white coat really? To me, it's a goal, an endpoint, a symbol of my long-awaited profession. But, if to others it is a source of perhaps deadly infection, then I'm sure I could set it aside for the good of humanity. I'd rather work to heal than to spread the plague.

So, will America be next to abandon the white coat?
Only time will tell. Surely in the end, we will end up doing the white, I mean right thing.

Read the full NY Times article below:
http://www.nytimes.com/2009/07/26/weekinreview/26vinciguerra.html

goodbye library...

2009-10-16T17:32:00.003-05:00

It's official. I am completely and utterly finished with tests in medical school. Yep, I have taken and passed Step 1, Step 2 CK, and Step 2 CS. I do not have a test to study for nor one that is incessantly hanging over my head. Any test that may arise during the rest of this school year matters nil, nada, zero, zip to my future career.

How does it feel you ask?
So good, my friend. So good.

the great unknown...

2009-10-12T13:52:00.005-05:00

We've been told time and time (and time) again that the fourth year of medical school is the "best year of your life." Now, since those were pretty strong words in a very confident statement, I actually believed them. I have been looking forward to this year since the past three, hoping and praying it would be everything they say it is.
Well, it isn't.

Fourth year has been stressful - with all the residency applications, clinical exam testing, and future career-planning. It's been tough trying to coordinate documents, applications, and interview scheduling.
While I do not agree that fourth year has been the best of my life (yet), I do acknowledge it has not been dull. We are almost there - we have almost made it to the end of medical school training and what lies ahead is unknown, scary, and very, very exciting.
It's fun to think about moving away to a new place and making a fresh start. It's also tempting to think about staying at the place where I began to love medicine, while serving those in the area in need. New beginnings are on the horizon and I have to admit, while I am terrified, I am looking forward to moving ahead with my career - and my life.

So, about next year - who knows where I might end up? We will have to take that road one step at a time.
Next up: residency interviews.
I should work on my handshake.

gratitude...

2009-10-02T13:57:00.003-05:00

I was recently told that "it is a privilege to take care of someone at the end of their life" and I couldn't agree more.
It's sad to see someone suffer from no doing of their own. It's sad to know someone's prognosis is very poor before they realize it themselves. It's sad to watch a family hope for a recovery when the outlook is dismal. It is sad sometimes, but also such a privilige. A privilege to view the struggle of human for his own life. A privilige to see straight into the heart of a man. A privilige to see unashamed love abounding in a family.

It's so very easy to forget how lucky I am.

the heme scheme of things...

2009-10-02T13:43:00.004-05:00

October is going to be a good month. It's beautiful fall weather, football season, and (here's the real reason) I am on a rotation that doesn't require weekends or nights.

911, what is your emergency?

2009-09-29T10:02:00.004-05:00

September in the ER has pretty much wrapped up. I was able to see many cool things and I learned a great deal about taking care of acute patients. Of course, the majority of the patients that came in to the ER weren't urgent or acute at all - they were more like clinic patients. They go to the ER for any complaints they may have - simply because they don't have doctors. Because they don't have insurance. Because they don't have money. Which brings us full-circle back to our ER - one of the only places in town that cannot turn them away.

So of course, emergency physicians treat gunshot wounds, motor vehicle collisions, broken bones, heart attacks, cocaine overdoses, all the many things that come to mind when you think "emergency." But, they also treat your everyday cough, flu, asthma, heartburn, arthritis, headache, and my least favorite, low back pain.
Because of their patient population, they are forced to know about a vast variety of ailments. They must discern between "very sick" and "will be okay sick," which sometimes can be very hard to do, especially since it's more of a suspicion or gut feeling than anything else.

Overall, it's been a good elective. I've seen how Emergency medicine can be fun and very exciting and I am leaving with a great amount of respect for those that do it. I am leaving knowing a little more about splinting, pain medications, trauma patients and how everything works from their side.
Most of all though, I am leaving with a full-forced confirmation that I am going to be an Internal Medicine doctor and, at a time in my life when the future is up in the air in so many ways, at least I know I've chosen well.

formaldehyde, powerpoints, and biochemistry...

2009-09-20T21:57:00.003-05:00

I drove past the library today and I was suddenly met with memories of our first year of medical school. I thought about our long nights in the library (we would leave when it closed at 11:45). I thought about the long days in the Gross Anatomy lab, hunched over those bodies, cutting through skin, fat, muscle, and bone. Even the faint smell of formaldehyde rushed through me as I drove past that tall building today.

We sat through 8 hours of class every day, trying to cram tedious bits of information into our tired brains. There were times when I thought, "if I could only get through this year" and there were days when I cried out of sheer exhaust.

It all seems like decades ago. I think my trip down memory lane served one purpose: to remind me where I've been. First year was a rite of passage, a must-do to be where were are now. And I must say, I am loving where we are now.
I will continue to relish in the fabulousness that is fourth year.

tunnel vision...

2009-09-14T22:29:00.004-05:00

Today I came to the realization that for the past three years, that light at the end of the tunnel was just a mirage.
It's actually just another tunnel.

So begins the search for three-year residency in Internal Medicine.

flu, drunks, and gunshots...

2009-09-01T17:25:00.003-05:00

August has come and gone. I will be working this September in the ER.
I'll be kicking things off with a string of night shifts - over Labor Day weekend.

This should be interesting.

comforting epiphany...

2009-08-25T20:50:00.005-05:00

Recently while on call, we were called to a Code Blue about a particular patient in the adult hospital. After attempting to resuscitate him for about 30 minutes, it was decided to practice comfort care and let him go. He was younger than me.

As one would imagine, this was a painful experience to be a part of. In the midst of the chaos, I scanned the room of 25 people, all sweating, all working their hardest to bring this patient around, and I noticed that every single one of them was visibly upset by the situation.

A weird thing to think about I know, but seeing this emotion obviously evident on everyone's faces comforted me. I was clearly the newbie to the code process, but these people have seen more cardiac arrests than they would like to admit and I'm sure it would be easy for them to detach themselves from the process.

It was nice to know, that after all this time, they still wore the emotion, they still took it hard, they still cared, and weren't in the least bit jaded.

exhausting all means...

2009-08-18T21:36:00.002-05:00

I wonder sometimes just how jaded I've become in my short span of clinical experience. It becomes difficult to like patients when they repeatedly lie about their health, refuse to take their medicines, and manipulate the system for their benefit. These patients are never "fun" to take care of, they don't quite warm the heart, and treating them is usually not rewarding in any sense of the word.

But....I must remember they are people - my patients - and while they have made poor choices regarding their health, they must be treated just as I would treat my family, friends, or loved ones. They are not fun, they are usually not truthful, but maybe, just maybe, one day my words won't always fall on deaf ears. One day perhaps they will wake up to the realization that they should take their health seriously.

That scenario most likely will not happen, but in the end, at least I will know I did all I could.

half empty or half full...

2009-08-11T20:14:00.005-05:00

Thus far, fourth year has been busy - in a good way. I woke up this morning at 3:45 am. And though I did not wake up cheerfully, I did wake up with meaning. I am a fourth year student now. I have responsibilities. People depend on my work. People actually listen.

Waking up at 3:45 wasn't fun in any sense, but knowing I was doing my part - and doing it well - well, that felt wonderful.

finally fourth year...

2009-08-05T18:57:00.003-05:00

After a magnificent vacation month, fourth year has started strong. I am currently on an Internal Medicine month in which our team takes care of people in the hospital with general medical problems.

It's extremely refreshing to finally be an M4. We're back to working long hours, rounding in the hospital day after day. Yes, I am tired. I haven't slept in over 30 hours and there aren't many breaks lined up in the future. But, it's what we've been waiting for - and we wouldn't have it any other way.

counting down...

2009-06-27T14:12:00.004-05:00

It's about time to see less of these:

And more of these:

sounds about right...

2009-06-22T22:09:00.001-05:00

I have been studying day and night for the past 22 days and I'm pretty sure it hasn't rained once all month.

Doomsday is June 30 and sure enough, rain is in the forecast.

put it in perspective...

2009-06-11T08:48:00.009-05:00

It goes without saying that some days studying are going to go better than others. Some days are frustrating and make you want to throw your laptop off the roof and others aren't so bad and can even give you confidence in your knowledge.
When you are in the library over 8 hours each day, you begin to forget what life is like "on the outside." You have to start getting creative at being entertained. I personally like to look out the window. I watch the cars drive by and I bitterly stare out at the beautiful weather. Lately, I've been seeing quite a lot of kids scurrying around in their short, pristine white coats. I was wondering where they all came from when it hit me - ahh yes, M3 rotations have begun for the class below us. Which means we are officially-set-in-stone M4's - the upperclassmen, the seniors.

Seeing them in their third-year frenzy makes the library look like a paradise island. Pass the sunscreen, please.

3 years down...

2009-06-07T16:07:00.000-05:00

Whew. Third year is now officially over.

How does it feel you ask? Well, I'm not quite sure. It's a weird mix of emotions that I cannot quite explain. Overall, it was a great year and 60 times better and faster-flying than the previous two. And even though we haven't yet earned the M.D. behind our names, we were granted a fair amount of responsibility and offered opportunities to actually perform.

Looking back over this past year, I realize that I actually learned a good bit. And not just the "what is this?" and "what should you do next?" questions that come with doctoring, but the life lessons, the refection, the moral of each story. It's funny because I've always thought of medicine as a way to minister to others, but when I look back over my first crack at it, all I can think about are the times that changed me. Yes, I was able to sew up a few abdomens, slice open skin, deliver some babies, and give chemo into the spinal cord to name a few. But, I was also able to see first-hand need, sorrow, joy, and grief, and even feel a few of them for myself. I won't forget those patients we lost or the babies we delivered because we had a part in their passage through life and they had a part in my learning about it.

And now, it's time to march on towards the month-long marathon of preparing for Step 2. It will not be easy, but it's comforting to know that even after all these years, I still have never doubted my career choice and in fact, even grown more excited about it. I guess I am right after all though. Medicine is a ministry, I just haven't quite yet become the minister I aspire to be.

speaking of odds...

2009-06-07T15:35:00.002-05:00

Unfortunate = six exams in six days

Cursed = six exams in six days + food poisoning

It's been a long week.

odds are...

2009-05-28T10:08:00.004-05:00

I read in the news today that a girl in Australia found some old lottery tickets in a drawer and cashed them in, hoping to gain a few extra bucks.
She ended up winning 10 million dollars. Her odds were 1 in 45 million. Now that's lucky.

Read the full story here.

buck...

2009-05-25T16:33:00.005-05:00

Happy Memorial Day!
Things are wonderful here in the tropical classroom wing of campus. With no windows in this secluded getaway, I am unaware of the weather outside - I hope it's gorgeous!
And what a work-out - my quads feel toned and firm after the 8 hours I've spent so far in this comfortable plastic chair today. And speaking of plastic, the cafeteria food is to-die-for in this summertime wonderland. It can't get any better than this! The view of the ocean is breath-taking on my laptop screen and melanoma watch out! - my skin is super-tan under this luminous fluorescent lighting.

I couldn't have asked for a more pleasant and relaxing vacation.

disheartened by humanity...

2009-05-19T21:53:00.002-05:00

With every career comes a downside - a part of the job that you'd rather do without, would love to ignore, loathe even. The practice of medicine is no different.
While as a physician, you are able to take a peek into some of the happiest moments of a family's existence, you are also forced into seeing the dark side of humanity - the side that we are all reluctant to admit we know is there and always has been. The side of people that we cannot fathom, the actions of those that leave us perplexed, downright broken - of both spirit and heart.

It's the kind of thing that's much easier to ignore, less lighter on the heart if it happened "far away, nowhere near here." It makes you want to wince, vomit, cringe, cry, fall into a puddle on the floor, close your eyes, run away - anything to avoid facing the truth.
And the truth is that not all people treat children the way they should.

Yes, the dark side of humanity can be very dark indeed.
This is my least favorite part of medicine.

hello world...

2009-05-19T21:16:00.006-05:00

It's finally here. The very last week of third year rotations. I am blessed to be scheduled for one of the easiest, most laid-back weeks of the entire year: newborn nursery.
It's been a breeze so far...and only one more day to go.

Up Next: 6 board exams and the ever elusive, all-inclusive Step 2 exam

This week is a fairy-tale nursery rhyme compared to the nightmare that lies ahead.

fatigue, malaise, apathy...

2009-05-13T20:28:00.003-05:00

I looked at my blood under a microscope today and it looks like I don't have the leukemia I've been certain of for the past 3 years. I don't even have an infection - just a good old-fashioned, textbook case of sleep deprivation.

wondering and wandering...

2009-04-30T20:33:00.005-05:00

It's not that I don't love sick children - because, don't get me wrong, I love sick children - wait, that sounds like I enjoy that the kids are sick. Perhaps I should say "I love taking care of children that are temporarily ill" or "I love children when they are getting well, not cursed with terminal illness" - but then that just makes it sound like I am evil and I don't love the REALLY sick ones.....

I guess what I'm really trying to say is...that much like today's post, my mind is all over the place.
And why is that, you ask?
Because we have 3 weeks left of Pediatrics. Wait, scratch that. We have 3 weeks left of third year. In 3 weeks, I will be free of clinical duties until August 1st, which is unbelievable/exciting/wonderful. My classmates and I, at this point, are pretty much over the whole come early, work hard, stay late M3 motto. We've wrapped up the year in our minds already and we are roaming the halls of the children's hospital like mummies, writing our obligatory morning notes, and presenting our patients with the typical words minus the zeal.

It's not really our fault. It's that time of year when things get monotonous and we realize we are ready to move on. We are antsy to take (and hopefully pass) boards and Step 2 and to move on to the greener, brighter pasture known as fourth year and affectionately referred to by many as "the best year of your life."
So, I try not to be too hard on myself for not wanting to take on extra patients/work - it's not that I don't love the children, it's just not going to work out between us. It's bad timing. It's not them, it's me - my heart's just not in it.

a little creativity goes a long way...

2009-04-24T18:58:00.005-05:00

Our lives as medical students aren't much different than those of our peers. Although we spend much of our time at the hospital, we've found ways to entertain ourselves and we use them as our link to the outside world.
For instance, I read the newspaper every day along with my morning coffee, just like anyone else - I just happen to read the patients' copies that are sitting at the nurses' stations - while I work on morning notes.
And I watch a good bit of television. Every single time we walk into a patient's room, I watch television. Cartoons, comedies, reality, you name it and it's on somewhere in the hospital.
I talk to my friends and family all the time too - I just use text messaging and email since it's rude for a student to be on the phone during rounds or in surgery.
And I don't personally subscribe to this, but some of my classmates find happiness in the "free" snacks that can be swiped off of used meal trays on any given floor of the hospital following mealtime.

You see, perfectly normal life right?

rock-a-bye-baby...

2009-04-22T13:58:00.005-05:00

One striking difference between the adult hospital and the children's hospital is the turnaround time. It's amazing how quickly children bounce back from their illnesses. They are in-and-out in no time. Adults on the other hand, have a gazillion medical problems and their sicknesses are mostly chronic, which means their hospital courses are often lengthy and complicated.

So far, taking care of kiddies has been short and sweet - which is nice for the last rotation of the year.

hit me where it hurts...

2009-04-17T16:44:00.003-05:00

I spent $1000 today. ON A TEST. Not a fun trip, shopping spree, or even a generous donation to a needy charity. A TEST.

Guess I'll be eating peanut butter and jelly for a while....

continuity of care...

2009-04-14T16:39:00.004-05:00

We began our Pediatrics rotation and lo and behold, my very first patient is a small baby girl who I helped deliver just 4 short weeks ago.

She sure has cleaned up since then.

next up: pediatrics

2009-04-10T14:50:00.004-05:00

We as students, are in many ways, just like our patients. We lack confidence, we need the doctors to encourage us along, and we are never completely certain if what we know is right.

There comes a point when the constant newness of material becomes less of a stimulant to learn and more of a burden, and we become just plain tired of being "the M3".
But the good news is there's light at the end of our tunnel. It's dim right now, but it's there - which is all that matters at this point.

manual labor....

2009-03-19T23:03:00.003-05:00

The labor and delivery floor of the hospital is exciting 24 hours of the day.

It's exciting because it contains diverse women superimposed alongside the spectrum of emotions that accompany birthing a child.
Women of all ages give birth on the floor to babies of all ethnicities and cultures.
There are the women who are ecstatic to be pregnant because they're desperate for a child. There are the women who deny they are pregnant and refuse to push. And of course, there are women of the many mediums in between.

There are the women in exquisite pain who scream obscenities and there are the women who (were smart and received an epidural) barely seem bothered by the fact that a living person the size of a watermelon is coming out of them.

There are many emotions on the labor and delivery floor and they often can change in one quick push. As women tend to do, they can be overly dramatic, often changing from madly insane to perfectly calm, cool, and collected in a matter of minutes.

It's quite entertaining...even satisfying in a weird way. It's pretty cool to be the first person to welcome a new baby into the world. It's also an honor to be able to share such memorable moments with these families.

That being said, the miracle of childbirth is both beautiful and utterly disgusting.

waste not, want not...

2009-03-10T19:29:00.004-05:00

I heard someone say once that being a physician is similar to being a plumber - you simply find where things are backed up and try to figure out how to fix it.

Let's just say someone was "backed up" today and we had to do some "plumbing". With our hands. And I almost vomited. Twice.

what's on your ipod?

2009-02-28T12:41:00.002-06:00

There is a guy who recently conducted a research study called "SAT Scores vs Music You Listen to" to find out if there is any correlation of intelligence and music.

It's no surprise that the overall highest SAT scorers listened to Beethoven, but it was exciting to see other high scorers listened to the likes of Sufjan Stevens, Radiohead, U2, Counting Crows, Ben Folds, and Guster.
What did the lowest scorers listen to? Beyonce, T.I., Soca, and dead last - Lil Wayne.

view the results here

count your blessings...

2009-02-17T20:25:00.003-06:00

This may be hard to fathom, but there are patients in every hospital that are happy to be there, even if it means they are sick. They are grateful to have somewhere safe and warm to sleep. They are ecstatic to receive a hot meal, a shower, even a conversation because a cold hospital room is a palace in comparison to where they came from.

Every now and then, it's nice to gain some perspective.
I am lucky.

coming soon...

2009-02-16T20:57:00.002-06:00

Next week will be our last week of Internal Medicine.
Next up: Ob-gyn and Pediatrics

Third year is quickly winding to a close.

this commercial makes me laugh...

2009-02-04T19:26:00.000-06:00

timing is everything...

2009-02-03T16:38:00.004-06:00

One thing about the third year of medical school that makes it different from all others is that you are always on someone else's time.
You will be on call when they tell you to, you will come in when they tell you to, you will eat lunch when they tell you to.
It can be quite draining living by someone else's watch.
It's especially difficult for a medical student to plan in advance because there is no telling who will be the one telling you what to do by then and it's a coin toss as to whether or not they will feel your time is valuable.

Luckily, many residents remember what life was like for them as third-year students and are a bit more flexible with the when and where. And, although they have more authority than we do, they are living by a schedule they didn't make as well - the ever-present, unwavering call schedule.

So, perhaps I should stop complaining now and simply adapt to this way of life - it doesn't seem like things will change anytime soon.

words of wisdom...

2009-01-27T20:12:00.003-06:00

They say you learn something new every day.
In medical school, we learn something new every hour, and if we really want to, we learn something new every minute. There is always something else to know. There is always more to learn. There is no way to know it all, although some will fool you into thinking they do.

In theory, if you are very dedicated to learning and furthering your education, you would be a good student - and learn every second you can. Every new patient is a new learning opportunity and a "good student" would never be able to see enough.

However sometimes, even during the best of learning opportunities, things get...boring. Your mind wanders. You lose interest. You wonder about the current news or weather. And sometimes, perhaps when it's been a long day, your feet are tired, you had a meager lunch and missed your morning coffee, sometimes you just want to stop thinking, stop learning, stop listening and run. Run out the door away from campus as quickly as humanly possible and in a beeline for the nearest coffee stand, clothing store, movie theater, any building that does not remotely resemble a hospital.

So maybe today I wasn't the best student. But I am reminded at times like these that I am only human, a mere 25 years old, still young and still....yes, I have to say it, still learning.

we'll worry about it later...

2009-01-16T17:25:00.005-06:00

The practice of medicine is amazing to me. I once thought it was simple logic and problem solving - if this is high, do this, if it's low, do that.
Come to find out that while it is problem solving it is not, however, simple.

Do you keep them on a medicine that makes them sick if it's doing what it's supposed to do? How many tests should you order if you have a high clinical suspicion? Do you keep probing for a cancer if you know the end is near? How long is too long on a ventilator?

I'm starting to see that medicine is full of decisions - there is no one way to do many things and there is an argument for almost any decision you make.
There are many instances where risk-benefit strategy comes into play and of course, good old-fashioned clinical judgment and gut instinct.

One day I will be forced to make these decisions...on my own. And be confident about them. With no one looking over my shoulder.

But, thank God, that is not today.

decisions, decisions....

2009-01-15T07:53:00.003-06:00

With it being almost February, our third year is flying by fast. Apparently, it is at this time of year when people start deciding what kind of medicine they will pursue. I wish I could say this confidently, but there are still 2 rotations to come and who knows what tomorrow brings. But, there is always today.
And today, I am thinking Internal Medicine.

old people rock...

2009-01-05T19:16:00.005-06:00

I am currently completing a 2-week rotation in Geriatrics, a sub-specialty of Internal Medicine. First of all, it has reminded me that I am fascinated by elderly people. Secondly, it has me wondering why others cannot share my undying adoration.

Yes, old people are slow - slow talkers, slow walkers, and very slow drivers. And yes, they've never used the word "dunzo," they don't have a clue who Rhianna is, they've never seen an episode of the Hills, and can't even begin to think about working an ipod.
(And I don't think they care to.)

It's like...they are old enough to know that, in the end, none of that stuff really matters.

And that's why I think old people could be the coolest people on the planet.
They're a sub-population of wrinkled Johnny Depps - people that never try or care to "be cool" - they just....are.

attached...

2008-12-16T21:07:00.003-06:00

Today we told a man that he will likely die soon.

It is a privilege to be a part of some of the most intimate moments in a person's life, to see into a family's hardest or happiest times, to be able to grieve with people about their dismal futures.

might as well be a bullseye...

2008-12-09T19:22:00.003-06:00

In many ways, my short white coat is a target.

It's a target to some "frequent flyer" patients of the hospital who are aware that a short white coat equals no authority whatsoever. It is for this reason they can yell at me to leave them alone each morning.

It's a target to anyone in a long white coat. To them, this difference in length automatically equates superiority, thus a pimping session can ensue at any moment totally at their discretion. Not only can they orchestrate question-answer sessions, but if they need anything, even a simple cup of coffee, the short white coat will do as told.

It's a target to any person who is lost in the hospital. They believe that if my coat is white, I surely will know the best way to direct them to CT, parking garage B, or the nuclear imaging department. They are sadly mistaken.

It's a target to all police officers on campus. Short white coat equals parking tickets - and lots of them.

My short coat loaded with papers, handbooks, and pens sometimes hangs heavy on my shoulders.....in more ways than one.

just one look...

2008-12-07T22:31:00.004-06:00

We have all heard this thousands of times before, but it's true. First impressions matter. You can really tell a lot about a patient (and his/her family) in the first 10 seconds of seeing them in the ER (or their room).
It's amazing.
It's pretty easy to pick up on family dynamics, compliance, education, hygiene, and sincerity in a few simple glances and comments.

That being said, I need to work on my introductions - maybe up my confidence a bit so they won't size me up as "frightened" or "inexperienced," both of which happen to be true.

step 2 looms ahead...

2008-12-04T19:45:00.001-06:00

The new doomsday date is set: June 30, 2009.

code blue...

2008-11-21T17:24:00.003-06:00

We have spent the last 2 days learning how to run a "code." A code is what it is called when a person goes into cardiac arrest and their heart stops. On television, there was a study that found 92% of people who coded ended up living. In real life, our success rate isn't quite so high.
This is real life and death and we, M3's are apparently now certified to know what to do, when to shock, which drugs to give, etc etc etc. And it is not easy.

I hope when the time comes, I don't take J.D.'s approach. (see below)

one pretty penny...

2008-11-16T20:36:00.008-06:00

One of the joys of our profession is that we make a commitment to lifelong learning. In practical terms, this means that we will forever be faced with exams.
The Step 1 exam was just the first of many hurdles we will face in our careers, the next being the illustrious Step 2. Step 2 is even more expensive than Step 1 because it has 2 separate parts - one of which must be taken in one of 6 cities in the US. So, once you add up the flight, hotel, and the 2 exam fees, you are looking at around $2000 for Step 2. And let's not forget the study materials, which will probably weigh in around $500.
So, Step 2 will add up nicely to around $2500.

Looks like I'm going to have to ask for exam fees this Christmas.

just live your life...

2008-11-11T09:37:00.003-06:00

the official party song of the holiday season

the end is near...

2008-11-11T09:30:00.003-06:00

Next week is the halfway mark for third year.
Done: surgery, family medicine, psychiatry
On deck: medicine, ob-gyn, and pediatrics

I can't believe we are almost there.

many of my patients speak this way...

2008-11-04T23:36:00.003-06:00

It's called tangential speech. No matter how many words or sentences he says, he just can never quite make his point.

round and round we go...

2008-10-29T20:50:00.002-05:00

You may hear many medical professionals speak of rounds. It may be described as "rounding" or "going on rounds," but it all means the same thing to an M3 - a nerve-racking, unavoidable chance for the residents and/or attending physician to grill you on any and every subject they please.
Rounds can be incredibly deceiving and intimidating. The point of them, of course, has nothing to do with an M3. They serve as a way to see all the patients listed on a particular service that day. During rounds, every patient's progress and care is discussed, and the appropriate changes are then made.
But for most M3s, rounds are the both the highlight and the most anxious part of the day. This is the only time of day when the entire "team" of caretakers is together, whether it's 5 or 17. This is the time when the knowledge of the patients becomes clear and random questions abound. It is the time to shine and also the time to sound like a fumbling idiot.
Needless to say, rounds can bring a mix of emotion - whether it be pride, anxiety, and/or discouragement. And by the time you get into the groove of rounding - it's time for a new rotation - with a whole slew of new patients, new residents, and a never-before-seen attending physician. Just when you think you've gotten the hang of things, it's new again.

And that is just how third year works - round and round we go....until we come around to M4 year.

loving third year...

2008-10-20T21:43:00.001-05:00

As students on the wards, we are continuously on the go. We are constantly moving room to room, looking up information, and writing note after note after note. And, in all the doing, I have realized that what we are actually doing is learning. It doesn't feel like we are learning, of course, but little by little, attending after attending, rotation after rotation, we pick things up here and there and then, all of a sudden, we just...know stuff.

It sure beats reading a textbook.

i have diagnosed myself several times already....

2008-10-16T21:02:00.004-05:00

We started Psychiatry this week. It's different than any other type of medicine - to say the least. They are a type of patient that we have never before interacted with. And, the first few days were a tad bit uncomfortable and scary, but now we love them.....all of them. Our patients are fascinating, brilliant, and many are full of life. It's easy to become so entranced by them that you quickly forget that they believe they are the daughter of Elvis Presley, the son of Janis Joplin, or my personal favorite, the goddess of fertility.

whirlwind of emotions...

2008-10-08T16:38:00.004-05:00

As rewarding as it can be treating patients, it can also encompass other emotions as well....

It is frustrating when patients don't keep up their end of the deal. The doctor is not a genie - one cannot magically heal without taking their medications.
It is heartbreaking to see someone dying, especially when they are young.
It is infuriating to see patients that have been abused, especially when they are too vulnerable to defend themselves.

But, it is joyous to see someone heal and know you were a part of it.
Needless to say, this feeling is my favorite, and it is the one I try to zen into when I want to strangle one of them.

quote of the day....

2008-10-01T17:39:00.000-05:00

"Your worst day as an M3 is always better than your best day as an M2."

I couldn't have said it better myself.
Happy October.

pick a side...

2008-09-28T12:43:00.000-05:00

There are many cliques in medicine. Yes, cliques - similar to your everyday high school cliques, the we-are-the-cooler-kids cliques, the we-don't-sit-with-that-group cliques - in short - there are many groups that just don't vibe.
There are many different people following one single patient in the hospital - the medicine team, the surgery team, his nurses, his respiratory therapists, his physical therapists, his social worker, etc, etc, etc. And sometimes it seems that everyone is fighting about the best way to treat them. Every group has an opinion and every group looks down on the others.

I am now 7 years out of high school, but in some ways, things haven't changed much.

specialties are not so special anymore...

2008-09-16T13:59:00.004-05:00

I read in an article recently that only 2% of medical students are pursuing a career in primary care. What does that mean exactly? It means everyone who is anyone is specializing these days.
Why? Well, there are many reasons, one being money. Primary care doctors (internists and family practitioners), as a general rule, make far less money and possibly work harder than many specialists. And with the growing number of specialists, they are losing their ability to treat certain disease states and perform several procedures.

But, my experience thus far in family medicine have shown me just how special these un-specialists are to their communities and to the patients they treat. The patients I have seen hold great loyalty and respect for their family doctors. They trust them to take good care of those they love, whether it be their grandfather, son, neighbor, wife, or mother. They have come in for check-ups, chest pain, cough and congestion, contraception, car accidents, you name it.
And to be able to treat them all is rewarding.

People say family docs and internists "know a little about a lot," whereas specialists "know a lot about a little."
As a STILL undecided medical student, I would settle for knowing a little about a little, and it finally does seem to be coming along - a little at a time.

new posts coming soon..

2008-09-09T15:48:00.002-05:00

While I am profusely enjoying my away rotation for family medicine in small town, Mississippi, I am desperately missing my closest friend: the internet

i'm no superman....

2008-09-01T20:12:00.007-05:00

I couldn't help but notice the multitude of medical TV shows on air to date. And I've got to admit, even with their unethical, comical, and dramatic situations, they are quite entertaining. With the many season premieres this month, they got me thinking - which is one is most like our real life?

Well, like ER, there are some good-looking residents walking around our hospital and also like Grey's Anatomy, some of them cheat on their spouses. And similar to the cases in House, our hospital sees patients that are exceptionally complex and rare. But, I'd have to say overall, our days as future physicians most resemble those on Scrubs - both tragic and humorous, full of witty banter, sleep deprivation and, of course, good music.

goodbye operating room...

2008-08-27T10:49:00.002-05:00

We officially finished surgery today and I couldn't be happier.
Next up - Family Medicine.

insert profanity here...

2008-08-19T17:12:00.004-05:00

Just as you thought your hectic day in the operating room was about to come to a close and you were heading to your closely parked vehicle thinking "wow, this 12-hour day has been efficient", SURPRISE! You are going on rounds! With the attending physician! No time to look up labs, or even what the hell is going on with your new patient - time to go. I hope you've got your info together because it is a seldom occurrence that an M3 handles this gracefully. You'd better know why they were admitted and each and every step of their care since they've been here. All medications, fluids, diets, and any and all reads from CT scans, X-rays, pathology reports, and any random thought in the attending's mind at that very moment are all fair game for questioning. And remember, you must know everything about the more complicated been-here-for-months patients. And even if you do know everything, (which you won't), you will most definitely be asked more questions far more detailed and complex than are in the scope of your knowledge and probably the residents as well - but lucky you! You will have the privilege to stand there and sweat, squirm, shake, or smile - whichever you wish - while the team of nine stares blankly at you. And please know that all questions will be directed to you, the M3, and each exciting questionnaire session will last approximately twenty-five minutes per patient. Surprise!

People do stupid things.

2008-08-17T13:05:00.002-05:00

Although exhausting, my surgery rotation has been quite exciting. I guess the most important thing I have learned thus far is people do stupid things, sometimes REALLY stupid things. In the ER, we have seen some random sights - anything from a pregnant girl who jumped off her roof to friends who shot each other "for fun" to the teenager to attempted to circumcise himself. It's pretty fun to hear their stories and wonder why in the world they made the decisions they did. And frustrating as they may be, these patients are easier on my heart to treat because, unlike others, they made poor choices - and there is a big difference between them and the innocent victims of tragedy, car accidents, or cancer.
So, you could say the ER is quite similar any pick of a reality television show - just regular folks making bad decisions. And that's what I call entertainment.