Night on Call

Well, here I am, another night in the hospital. I decided to plan ahead and took about an hour nap, maybe slightly longer, before coming to work at 7pm, and took a 100mg caffeine tablet. Just took my second 100mg tablet now, at 12:45am. I was anticipating it being a nonstop night, however everything is all organized now, did a vaginal delivery, my notes, etc. and now... just waiting for admits or for all hell to break loose. This is just a weekend call though, 7pm to 11am the next day (at most). OB and Pediatrics. This past week and this coming week I am on surgery. It's been a nice change of pace, and getting home at a more reasonable hour as well. My attending looks and sounds exactly like Hugh Laurie on House. It's rather uncanny. One of his patients even pulled me aside and asked, "Does Dr. so-and-so look like Dr. House to you?" I don't know if it's surgeons in general, but he also has a lot of interesting stories. My previous surgery rotations were also filled with story telling. I wonder if it's because sewing, cutting, spreading, etc. isn't super cerebral and you can just chat while doing it. I had my in-training exam last week - I kinda just rushed through it... I know I probably should have taken it more seriously but...meh. Just wasn't in the mood, and at this point I feel like either I know it or I don't. Well, next weekend I get both days off, yay! I'll be driving over to my parents for my dad and sister's birthday - should be fun! Anyhow... guess I'll go back to studying random stuff... what to study, what to study...

1st Week in OB/GYN

Well, almost done with my first week in OB/GYN.  The first day we were on gynecological duty, so we were seeing patients in the hospital for ovarian cysts, pyelonephritis, etc.  However, we did assist on two C-sections and I got to observe a vaginal delivery.  It feels very odd to see a family react to a "birth" in scrubs while surgery is still technically taking place (suturing everything up, still have half the environment sterile).  The vaginal delivery setting makes a lot more sense - the delivery I saw only took about 40 minutes too so that was a pretty quick delivery.  Watching the men is the funniest part because they look terrified and helpless at the same time - after all, it's not like they can relate in any way and they can't really participate in the actual process - she's doing it all herself.  Of the two delivery methods, I'd definitely rather do the vaginal one personally (with epidural of course) - it just looks a lot more impressive.  

The next time I was in the hospital we were rounding on patients and doing a lot of gynecological surgeries so several hysterectomies and salpingo-oophorectomies (tube/ovary removal).  Not the prettiest of surgeries...especially when they do a hysterectomy through the vagina.  Before heading into this rotation, I had no idea that OB/GYN doctors do so much surgery.  Anyway, tonight we are on-call from 7:30pm to 7:30am, so I best be getting off to that - should be interesting.  I like night time, and I'm packing an energy drink - I hear there will be many deliveries.  I will post about it next time I have a spare moment!

In other news though, I got my loan disbursement, so money is not a problem for a little while.  I emailed my school contact about year 4 rotations and I am still studying for the boards - Feb 4.  

Starting Family Medicine

First let me say...wow.  Family Medicine is such a far cry from surgery.  The preceptors are so much more talkative, nice, and helpful - the interactions feel so much more normal.  We have been seeing a good variety of patients, including patients with asthma, bladder infections, osteoarthritis of the shoulder, palmar psoriasis, cirrhosis of the liver, and doing plenty of patient education also.  I've been grilling most of them about how they like working for Kaiser, since I am very interested in working for Kaiser one day - and all three pretty much love it.  Two of them are a married couple (though with different last names) and they used to have a private practice and she says they made more money in private practice, but it was much more stressful, and they could never take vacations, and had no life, compared to now.  Also, watching them deal with the electronic medical record system looks very appealing - they can finish encounter notes so quickly.  I told them I came from surgery and they chuckled, saying that I'll have the briefest notes of all of them after that, since surgeons are really brief.    

The biggest difference is in the question-answer feel - when I ask questions, I feel like they acknowledge that I am a student and have no problem telling me things.  When I tried that with the surgeon, he seemed more of the attitude of not wanting to teach me about stuff like that, that he would rather have me self-study and just quiz me when he felt like it.  Maybe it's because Family Medicine doctors are more relaxed and used to doing patient education.  It's a fairly stress-free rotation, so far.  I finished my first weekly quiz, most of it was either easy to look up or easy to discuss.  We have a quiz every week or two on blackboard, so we have to go through those.  I also need to be working on some readings and doing practice questions I think, but it's tough to get to everything when I get home at 6pm and have been up since 6:30am or so.  

Last Day of Surgery

Friday was my last day doing general surgery - we started out that morning at 8:30am with a patient with swelling of the left leg of unknown etiology - they had already ruled out DVT, osteomyelitis, and had essentially ruled out infectious agent, since there was no gas visible on any of the X-rays, and there was no surface involvement.  When we went in to get a muscle biopsy, his leg fat was swollen with fluid, just watery fluid - so there's a chance it was severe lymphedema or venous stasis due to CHF or another underlying problem.

Anyhow, I got to stitch that guy up and then ran off to find the doctor at his clinic, where we saw a few clinic patients, I helped dress some wounds, etc.  At the end he met with me to discuss my review, which consisted of him mostly asking me questions about how I liked the rotation.  He also asked me to grade myself, and I was a little on the humble side, so he gave me a little talk about not selling myself short and to focus more on selling myself and recognizing where I am doing well - especially for residency applications.  But other than that, he said I have done very well and that if I continue to perform like this in my later rotations, I will be successful.  

Second to Last Day of Surgery

Today was fairly interesting.  Our first patient took 3 hours.  She was a morbidly obese wheel-chair ridden woman with diabetes and she had a major ulcer (about as big as my palm) on her lower buttock by her vagina and one of her labia had a lot of sores, from when she has self-catheterized herself.  The surgical solution was to remove the middle portion of both labia (they have to match) and cut a flap, cauterize the big sore, and cover it with skin.  Her labia were gigantic, each one was about as wide as my arm.  This was, again, due to extreme obesity.  After three hours everyone was pretty sick of the case.

The second one was a gallbladder surgery, open (not laparoscopic) because the gallbladder was actually a "porcelain" gallbladder, a term to mean that the gallbladder has calcified.  There were also significant stones in it, and it was chalk white (hence the name).  Normally it is rather radiopaque, but the radiologist make any major comments about it, so it was missed initially until the first attempt at a laparoscopic repair.  Once it was out, it was rock hard - and the walls were pretty thick.  Inside instead of the typical greenish-yellow bile, there was this light yellow fluid, probably mostly cholesterol.  

The next two cases were lumpectomies for breast cancer, not much to say about that.  Didn't really get to do any suturing today, but tomorrow there is one surgery - a leg incision and drainage, because it is a cellulitis case (most likely).  Had to buy some thank you cards today, and should get some studying, but a friend is coming to stay with us for a week so I shall be very preoccupied with fun social stuff.  

Long Day of Surgery

Well, another surgery day is at an end. I was first-assist for a cholecystectomy and a thoracotomy plus decortication. The cholecystectomy was fine, went about as expected - and I sutured up two of the short incisions and they looked quite nice. The thoracotomy is where it starts getting interesting - it was on this 22 year old obese autistic individual, very obese. We had to go through 4 or 5 inches of fat to get to his ribcage where we had previously inserted a chest tube to drain pleural effusion. The guy had a really bad pneumonia infection and it had caused empyema, so we needed to go in, break a rib, spread his rib cage a bit, and detach as much of the pus-covered fibrinous exudate as we could - it was really remarkable how much there was. Imagine peeling really glued on labels off a glass beer bottle, except instead of glass it's lung tissue and the label is dense clotted blood, pus, exudate, and fibrin material. It took a total of 2 hours to do the surgery.

After that I observed a cholecystectomy, but this was kind of an odd case because the woman had a standalone piece of liver, about 2 inches by 1 inch by 0.5 inches, living by itself on her gallbladder. It was really weird, it had it's own blood supply and everything. At any rate, same procedure took place - removed the gallbladder along with that tiny chunk of free-living liver, and stitched the woman up. She took a half hour to come out of anesthesia and even then she was too weak to do much so they decided to intubate and let her sleep and recover overnight.

In other news, my car needed to be repaired, battery/alternator trouble and the cost is gonna be about $2,000 - really painful to think about. At least I have loan money for this sort of thing - unfortunately they still haven't disbursed the majority of my loan money because there is some problem with my stafford loans over at the main university headquarters on the east coast and they are waiting to hear back from them. If I don't hear anything tomorrow, I'll bug them again.

Also, I contacted an infectious disease specialist who works with AIDS patients and he told me to email him so we could set up the rotation - I haven't heard back yet, but hopefully tonight or tomorrow he will respond and I'll know if/when my infectious disease rotation will be. I'd really like to do that, we shall see.

Starting the Last Week

Well, after a nice weekend with friends, boyfriend and family, time to get back to work. Today I helped drain a cyst, and dress a wound, as well as finishing up the suturing on a VAP placement. It worked out pretty well, the suturing looked good, and the doctor seemed to be in a decent mood. Got out at a decent time, but ended up having to take the car into the shop. I have a rental at the moment, which is kind of a hassle, but at least it's getting stuff fixed and I'm getting a detail, so it should be nice and pretty when it gets back.

Later this week there are a few other surgeries, nothing particularly radical, but it looks like a nice load, nothing too stressful. On Thursday a mutual friend is coming to stay with me and my boyfriend for a bit and there should be some nice social fun going on this coming weekend. Next week on Monday I start my Family Medicine rotation at Kaiser Permanente - here's hoping it works out all right.

Connecting with Patients

Despite this being a surgery rotation, where you spend most of your time cutting into unconscious people, I'm getting to connect with quite a few patients in unexpected ways.

First off, yesterday during clinic hours I was interviewing a 34 year old Hispanic woman and getting information about her concerns about a benign lump in her breast. However, as we were talking about her allergies (raw onions) and I asked if anything else made her throat swell up like that, she said that the last couple weeks her throat has felt more swollen - like there was more fullness. She also felt like the back of her tongue was swelling more. Considering her race, age, gender, and that symptom, I thought I'd ask her a little bit about thyroid problems - turned out she was having cold intolerance lately, extreme fatigue, difficulty sleeping, palpitations/chest pain/anxiety, and her father and aunt on her father's side both have thyroid disorders. I asked her if she had talked to her primary care physician about this and she said no, that her PCP doesn't really talk to her about that much - that she's really rushed. I told her that I was thinking it could be a thyroid problem, that if I were her doctor I would want to check it out but that I would run it by the surgeon and see if he was willing to look into that. I mentioned it to the surgeon, as humbly as possible since I am terrified of sounding like a know-it-all medstudent who tries to diagnose a million things, and he immediately said "Sure, we can order a thyroid panel."

I don't know if it was the fact that I had actually made a physician-like decision in a patient's health, was suddenly afraid that I might be wrong or out of my mind, or just that the surgeon had actually taken my concerns seriously - but I was baffled for a moment. Of course, it could be that she is just tired from having two young children, maybe she is anxious from having a breast lump, maybe the chest pain is related to muscle pain in the breast, maybe the throat swelling is just an incidental finding, or maybe her cold intolerance is just in her head but it was exciting to actually have a tiny feeling of what it is like to be a physician.

In another situation, today after we finished what we thought was the last surgery for the day, it turned out that we were going to see an appendectomy patient. There was a 9 year old girl in the emergency department with acute appendicitis. Before I knew anything about the case, the surgeon told me to go to the ED to check out the patient and wait for him there. When I got there, I found an adorable teary eyed 9-year old Hispanic girl and her father, grandmother and uncle. Her father spoke pretty fluent English, but her grandmother and uncle both did not. Since they seemed to understand me when I spoke Spanish, I carried on a conversation with them, telling them a little bit about the surgery, that she would be put to sleep for it, that I would be there in the OR with her. The grandmother was keeping it together pretty well but when the little girl started to cry she started crying too, saying to me (in Spanish) "Since we cannot be there, can you please speak to her on the way to the room and in the room until she falls asleep so she isn't so afraid? Since you speak Spanish..." I almost started tearing up there and told her I would.

Since I was taking on the task of guiding this little girl to the OR, I took a moment there to talk to her a little, tried to get her mind off the impending operation by asking about brothers or sisters, about pets or anything. I remembered a story about Madeleine and how she actually had her appendix out and asked her if she knew the story and she said she did so we talked about that a little bit before the Anesthesiologist came. He was very nice as well and spoke very broken Spanish so that helped too.

When we got everything in the OR set up, we got the laparoscopic tools set up and the surgeon let me staple/cut the appendix out, as well as bag it in the collapse-able bag and pull it out through one of the tubes. He was getting a little antsy to get out of the OR near the end, probably since it was an unplanned surgery, so it was a little nerve-wracking but my fellow PA student reassured me that I did a great job and that it was really exciting to watch. Quite a fun filled past couple of days. We were going to discuss how I have been doing on this rotation, but he said we could do it tomorrow, so tomorrow morning I'm to remind him about that. No clue what he will say, but hopefully it'll be good. I'm glad my Spanish-speaking skills are coming in useful these days - now that I think of it, one of the other Spanish-speaking patients' daughter (middle aged) who was translating for me in the room on a clinic day complimented my Spanish skills in front of the surgeon. I wonder if he sent me to the room early today so that I could talk to the family with that in mind.

Either way, tomorrow is another clinic day, and hopefully constructive feedback from him about my performance, and maybe that woman got her thyroid function panel done for me to check on it. It'd be exciting if I successfully diagnosed someone with something that other doctors hadn't identified yet.

Colectomies Galore

One of the days last week that I was shadowing surgery had two Colectomies in a row, in which a portion of large intestine needed to be removed and reconnected (anastamosed). It was interesting because I got to see two very different approaches to anastamosis.

The first case was a patient who had a very large volvulus, or twist, in the ascending colon. A volvulus can occur in the ascending or descending colon, because those portions are fixed at the hepatic and splenic flexures (respectively) and the lower portion is hanging freely, with the potential to get twisted about itself. The volvulus was pretty big, about a foot long and 1/3 of a foot in diameter. After it was clipped off on both sides and removed, there were two pieces of colon that needed to be anastamosed and those were connected the same way I mentioned in the previous entry.

The second case was a patient who had had an emergent colectomy and colostomy bag put in, without a reanastamosis, so in this case they were going back in to finish up the colectomy, and anastamose the pieces to the rectum. The difference in this case is there is not enough room by the rectum for a surgeon to work very easily with his hands and clips, so instead they did the majority of the procedure laparoscopically. Once they had prepared the colon end that they wished to connect to the rectum, they inserted a circular disk with a metal male port perpendicularly. This produced an end of intestine that had a circular disk within the very end, and through the center (where the lumen would be) the male prong was sticking out. They then took another circular disk, except with a female port, and pushed it up the rectum to the point that they wished to create the new lumen and pushed the prong through the wall of the intestine at that point. They laparoscopically connected the two ports, producing a metal connecting rod between the two disks. The metal connector then approximated the two disks, to the point that there was a seal between the two parts of the intestine. The disks then cauterized the area and the entire apparatus was removed, leaving in its place a new lumen created between the sigmoid and the rectum for bowel contents to bypass the area that had been removed. I had never heard of this type of procedure before, so I was kind of clueless as to what was going on for the first half hour of the procedure. Mental note: Find a page later to link to procedures so that it's easier to understand what I am describing...

Well, more surgery clinic appointments today - I should also be meeting the new PA student from Touro who will be sharing my preceptor for the rest of my rotation.

Loooong Day

Well today was extremely long. Kinda surprised it didn't FEEL longer. Got to the clinic at 8:30am, expecting a short clinic day getting out around 12:30 or 1:00 - instead, the doctor was about 20 minutes late so we had a lot of catch up most of the day, and I didn't have the PA student with me so I had more patients to see than usual. I also did some injections and assisted with a skin nodule extraction - outpatient minor surgery at the clinic. Mostly stressful just because I wasn't sure how to do any of it, not that it was difficult. By the time the patients were gone it was probably 1:30, and I was trying to finish up my SOAP notes. In the meantime, the doctor was trying to get a bed in the OR for a patient with an ulceration in his intestines and was having trouble. Eventually it was scheduled for 3:00 PM, so we drove over to the other hospital around 2:15pm, I got dressed, checked the OR list of procedures to see how on time they were, and then rushed to the physician lounge to get something to eat or drink. Found an energy drink, elected to use the zero carb one, downed that while I waited for 3:00 to roll around, around 4:00 maybe the surgery started.

Today we cut into the first patient's abdomen, and pulled the intestines out of the abdomen and onto the patient's belly so we could look for any perforations that were causing the patient to lose fluid into her peritoneal space. This consisted of cutting away the connective tissue holding the intestines coiled and going through it at length to find stuff. It really looked like an evisceration. Got to see a bunch of new anatomy, and it was an interesting exploration - didn't find a perforation and the fluid was all clear, so it was probably from the pleural space. After that, the doctor had to do ANOTHER one, except this time the guy almost certainly had a perforation in his gut somewhere - he was in a lot of pain. We did the same thing as for the first patient, except we found the hole in the guy's sigmoid colon and the fluid in his abdomen was brownish. Yeah, pleasant. Anyhow, I got to see how you cut out a segment of colon and reconnect it. There are a lot of specialty clipping tools and ways of doing it that I hadn't thought of - it was very interesting. I mean, when you think about it, how do you get a piece of large intestine out and connect the tubes without spilling fecal matter all over the place? With lots of nifty tools and tricks, that's how.

Anyway, got through all that, by the time all this was over and the patient was back in his hospital gurney, it was 8:00pm. SO..... basically a 12 hour day. A few pluses: Saw some new procedures, assisted in new procedures, talked more with the surgeon, and people (including the surgeon) were addressing me by name for the first time. Guess they're starting to get more used to me.

As an aside, for anyone who has played RPGs, I started feeling like a total NPC today - following him around, if I lingered and he got away from me a bit I would jog to catch up, I'd be stuck in doorways or be hindering things (but honestly mostly helpful). When I got that thought in my head it was hard to not laugh. Another day of surgeries tomorrow, hopefully just the three that I know are scheduled. Time to take some ibuprofen for my aching feet - I didn't know we'd have surgery so I stayed in my dress shoes all day and my feet are KILLING me!

General Surgery Rotation - Week 2

So far the week is going well. Monday we started out with some clinic cases, and then we headed to do a thoracic surgery - removal of the lower left lobe of the guy's lung. It was pretty interesting - had to break open the ribs, and then slowly remove the lung - it was pretty involved. Amazing that lungs, which seem so delicate when you read about them and such, can handle a person shoving them around with their hand. I got to feel the diaphragm, descending aorta, lung tissue, saw the heart beating in the guy's chest - feel pretty privileged to be able to partake in things of that sort. Few people can say they've had their hands inside a living person's rib cage.

Today went well also, had a few surgeries, this was the last day the PA student was there, so for the next few days it'll just be me and the surgeon until the next PA student arrives. I assisted in a neck lumpectomy and a breast lumpectomy - it's amazing how vascularized fat is. With the neck fat there were sprays coming out here and there - with the breast tissue I've come to expect that. Had to find the lymph node, and I did an essentially complete final suture - the surgeon actually said it looked good, so that felt really good - all I really want is to not look like a complete idiot. Anyhow, tomorrow is more clinic patients - maybe I will be done by 1:00 or 1:30pm - that would be nice, since today I was done at 4:30, and I want to get more of my studying done.

In other news, my boyfriend and I have our 5 year anniversary coming up - we'll be dining somewhere in San Francisco - should be nice.

Day 3 and 4 General Surgery

Yesterday I went in and took histories most of the morning, tried taking a thorough history, then tried to make them more focused. My notes are looking more proper, I think it helps that we didn't have any minor procedures that day, which are not quite surgery, not quite a normal visit, so those are a little challenging to document. Starting to talk more to the surgeon, which is good. He's warming up to me, I suppose. His 1:00pm surgery ended up getting pushed to 3:30pm, so me, the surgeon and the other student mostly sat in the physician lounge chatting for a while. It was nice, getting a bit more comfortable. Then we went to the surgery, it was an exploratory laparoscopy, which was interesting to observe. Ended up extracting an ovary and ovarian cyst (benign).

Today he had a hernia repair in the morning, during which I assisted. I got a few pimping-type questions, which was fun, and the anesthesiologist joined in as well and he was impressed that I seemed to know stuff - "It's refreshing having bright students come through." I don't know if it helps that I'm a girl, but at any rate, it was nice to get a little positive feedback during the experience. I also lucked out that the questions I got were rather infectious-disease related, which of course is one of my main interests. I still got to make the first incision on this, and also tied off the last suture for the mesh.

The next surgery I observed, it was a fistulotomy repair. The scrub nurse looked like Dr. Chase from House (teehee). After that we went to a different hospital and I assisted with a VAP insertion (Venous Access Port), in which we insert a tube into a vein and there is a subdermal port attached to it which is used to make it easier to administer chemotherapy and such. So, my part in it was identifying the trajectory of vein via syringe needle, then inserting a guide wire about 2-feet through the jugular vein, guiding a plastic tube around the guide wire, and then removing stuff after we got the port connected. I also got to do the subcutaneous suturing. Final surgery was observing another hernia repair and that's the end of the day. We were expecting to do a thoracotomy, but that guy got postponed to another day. I also got to watch a chest tube insertion on a guy with pneumothorax and lung cancer. Interesting, for sure.

Oddly enough, I find that doing the surgeries themselves is a lot more interesting than meeting with patients and writing SOAP notes after the encounters. I guess because it feels like a lot of busy work and they don't feel like regular patients since they are all referrals for surgery it feels like a pointless exercise. Also, in surgery you aren't dealing with people, you're just dealing with their flesh - it's like a mini-crafts project almost. You have cutting, pasting (I guess cautery can count as pasting - or cooking, haha), sewing, organizing, sculpting... I duno. It's interesting. I still highly doubt I would go into surgery, considering the years of training, the unpredictable hours, and constant standing and high risk of lawsuits, but this rotation is turning out to be a lot better than I was expecting.

Day 2 General Surgery

Today I had my first actual scrub-in surgeries. The first surgery was an umbilical hernia repair - I scrubbed in a bit early but got some of the awkward "what do I do" stuff out of the way at least. When you are 'scrubbed in' the scrub nurse fits you with your sterile drape and gloves that you will wear for the rest of the surgery - after that you cannot touch anything that isn't within the sterile zone. So they were still prepping a bit and I had to stand by - beginner's mistake, and at least the surgeon wasn't there yet to notice.

Me and the other student are alternating in assisting, so I was first in assisting, and got to make the first incision. The surgeon was a bit more relaxed and talkative today, maybe because he is in his element and not having to worry about patients (interacting with the person, I mean, not the body). After that I mostly held clamps, dabbed gauze, and tied off a few stitches. We inserted a mesh to prevent the herniation from protruding. The next surgery was in a different hospital so we sped over there in our respective cars and this time the other student scrubbed in, so I observed. It was rather short, another hernia, so that wasn't too bad.

During the lunch hour, there was a cancer session where radiologists, surgeons, and others meet to discuss particular cancer patients and approaches to diagnosis and treatment. We got free lunch, so that was nice - the doctor's lounge also has regularly stocked varieties of drinks, including energy drinks, so that's pretty awesome - on surgery days I get free energy drinks ^_^

After that we observed half of a double mastectomy and I assisted with the second half - this time both the surgeon I am following and another surgeon were working, and I was mostly assisting the latter. They are both nice, were chatting with each other about their residency experiences in various places, etc. At the first hospital there were eye shields, and I was really wishing I had an eye shield for that mastectomy, since there were a lot of small blood vessels getting cut here and there, and a few times it barely missed my face. Again, mostly holding, snipping, or dabbing. Got out about 4:30 PM so all in all not a particularly long or troublesome day. Tomorrow I report to the clinic around 8:20 AM and we have a surgery in the afternoon around 1:00pm so we shall see how that goes, whatever it is.

Day 1 General Surgery

Back from vacation, time to hit the ground running -

So, started my surgery rotation today around 9:00am - I knew the doctor would not be there until around 10:30am due to a previous surgery so I reviewed the patients who were coming in that day, and then did patient interviews. After doing an interview, once the doctor got there, I would follow him into the room and he would examine the patient. The two nurses/PAs are quite nice, and there is a PA student from my school who is there with me for the next few days so they all showed me the ropes a bit - what is disposed, what is washed, etc.

At the end of the day I wrote up SOAP notes of the various patients, which includes their history, observations, the assessment, and plan for their treatment. Spent about two hours doing that, hopefully I'll go faster next time. Tomorrow we have an inguinal hernia surgery and possibly a bilateral mastectomy - there's also a cancer meeting about one of the Dr's patients but I don't know if I get to go to that.

For the rest of the evening, going to look up information about inguinal hernia surgeries, mastectomies, and other surgeries that I saw today, and get started on my reading assignments. One observation about the surgery rotation - I basically have to have as much initiative as possible, so suggest helping with things, follow the doctor into rooms - no waiting to be told what to do or asked to do this or that. Good training, requires a lot of energy though. We'll see where this goes.

Post-COMLEX Step 1

Well, that was a long test, that's for sure. So, I took COMLEX on Monday, it is a 400 question test, separated into sections of 50, no real theme to the sections, they feel like pretty much random collections of topics, and you get 60 minutes per section and a 40 minute break for lunch after the first 200 questions. Took BART into San Francisco, arrived at the Prometric testing center at 7:30am, started the exam around 8:15am after everyone got checked in, pockets checked, scanned with metal detectors... at least cheaters have a difficult time. They also do rounds in the testing area every 10 minutes.

Anyhow, there were quite a few repeat questions - what bug is causing this infection, what does this slide indicate, it's all a bit of a blur right now. I kept tabs of how many I was "guessing" on, and by the end it felt like maybe 40% of the test was my best estimate? But the questions are each weighted between 0.5 and 5 points, so it's really hard to know about how many you need to get right to pass or get a proper score. My practice COMLEX exam had me at slightly above average, and my question bank percentages were fairly respectable, so I almost certainly passed and most likely have a score acceptable to most Family Medicine, maybe some Internal Medicine, residencies.

I also got some information about my General Surgery rotation which I am starting on 7/18/11 - clinic days are Monday, Wednesday, and Friday - where he will have me practice taking patient histories and then we will do physical exams together; Tuesday and Thursday are surgery days.

The surgeries I can expect to see performed include:

Inguinal hernia

Umbilical hernia

Lap Chole (Laparoscopic Cholecystectomy)

Excisional breast biopsy

Appendectomy

Injecting hemorrhoids with a sclerocing agent

Port a cath placements

Pilonidal cyst excisions

So... lots of stuff in the future! I'm glad the clinic days are so short, as it'll leave me a lot of extra time for studying and personal time =)