USMLE Step 2

It has been a while since my last post.  I've been busy studying.  Questions every day and whatnot.  Instead of Neurology, there was a scheduling conflict and I got switched to another Radiologist.  Luckily, this guy has a lot more to see during the day than the first guy, so I got a lot of experience seeing different plain films, CTs, MRIs, ultrasounds, etc.  Some of it will hopefully help on the exam tomorrow.  After this week I head on to ICU, which will likely be intense, have long hours, and be rather stressful.  Probably will have some weekend call days.  

After tomorrow's exam, there won't be any more standardized future-of-medical-career exams until Step 3, which will probably be after I get into a residency program.  In the meantime, I have to work on my application to residency - write some personal statements, research programs, etc.  It will be stress of a different nature.  We move to Davis in September, and then near the end of September I start the Sub-Internship at my number one potential spot for residency, so hopefully that will go well...   Yet more stressful stuff to worry about.

Tonight hopefully I can put most of that out of my head and try to relax a little bit.  After tomorrow, no more endless practice questions for a while.  Oh yeah, my 6-year anniversary of having been dating my fiance is tomorrow as well, and I should also be getting my COMLEX Step 2 written exam score back as well.  We aren't celebrating our anniversary until Friday, but either way, lots of stuff going on.  

Psychiatry Week 1

This rotation is a breath of fresh air compared to the previous one.  First off, our preceptor is a nice middle-aged white chap who I have no trouble understanding and who likes to sit and chat about psychiatry.  Second, it is not a high-stress environment, despite being surrounded by many psychotic patients (in the medical sense). Third, I have a fellow classmate with me on the rotation, so we have each other to hang out with during lunch and on breaks.  The patients are all quite interesting, and we get off relatively early most of the days.  Also I get to wake up at 6:00-ish instead of 5:00-ish, like I did last time.  I still have a 1.5 hour drive each way, but again, plenty of lectures to watch on the way.  

Another nice thing about psychiatry, is I know a fair amount about the topic so it's less stressful, less pressure.  I have another week here, then the week after we have a week of mandatory lectures and sessions at the main campus that everyone in our class has to attend, so I will be making a much shorter commute each day.  The final week I have to fly out to Pennsylvania on Tuesday, take the physical examination portion of the boards on Wednesday, then I fly back on Thursday.  I am most looking forward to finding a really nice restaurant in the area and having a solo celebratory meal after the exam.  It will be an awesome feeling.  

Then the next big events will be the board exams.  

I also cancelled my family medicine rotation up at the hospital I was at previously for internal medicine - it was scheduled for mid-December to mid-January and I do NOT want to be doing a sub-internship with long hours at a program that I really do not want to get into (not the best environment, and word has it that it is a very weak program) and which would require long hours and that 1.5 hour drive.  During the holiday season.  It's not worth it.  I'll fill that time with another elective of some sort.  I should send some requests for those sorts of things now.

Off off and away!

Internal Medicine - first 2 weeks

Internal medicine for the first four weeks is to be outpatient, so I am essentially back in Family Medicine.  The only difference is we see a lot more older patients, and instead of being with one doctor for four weeks and another for four weeks, I am with a total of 4 or 5 different doctors, and usually two different ones in a single day - one for the morning and one for the afternoon.  It's a challenge getting used to what they expect in terms of presentations and their personalities - harder to get a good rhythm going, so it feels more chaotic and stressful.  Also with all the older patients that I see, I can't help but feel a little depressed thinking of myself one day being where they are with lost loved ones, being unable to get up and around, unable to hear, or demented.  Two days a week I work with a doctor or a nurse who each goes to skilled nursing facilities.  I see a lot of demented people there, who are so far gone they can only half-feed themselves, smack their lips, and don't recognize their family members - who wish they would hurry up and die because they are quickly destroying their life savings.  I asked and you are able to stipulate in your advanced directive that if you are unable to recognize family members or have an acceptable quality of life for someone of your age and physical condition (not mental) that you give permission to discontinue all medications, including ones that were being given prior to mental deterioration.  The catch with dementia is you can't stop any treatments once you've started, but you can abstain from starting treatments.  So a patient with palliative care lung cancer patient starts bleeding per rectum, you don't have to go looking for colon cancer, you can just keep doing what you're doing and give narcotics.  It's a tragedy so many families are trapped watching the husk of someone they once loved deteriorate further and drain their finances that could put their grandkids through college, or help pay off debts.

In other news, I've been adhering to a stricter study schedule and trying to make sure to get my quota done each day - if I don't, it means no fun time.  Last week it definitely cut into my fun time, so I have to become a faster reader...  I also have to give a presentation next week, so this coming weekend will probably be spent working on that.  Also been busy trying to get rotations set up for fourth year.  Soon I'll need to call another place in Sacramento, but hopefully after I hear about two other sites because I don't want to be stuck without a rotation...  So much stress.  Wish I could just be done with medschool and onto residency.

Last Day in Peds

Last day - it's been a fair 6 weeks.  Aside from being sick for one of the weeks, it's gone really well.  My preceptor thinks very highly of me and I've gotten my timing, writing, and presentation skills down as far as history and physicals go.  I'm looking forward to seeing adults again - kids are fun, but honestly, only if they can talk.  Babies are kinda boring.  Either way, seen a few good cases, gotten a couple challenging things to diagnose, but for the most part I refined my examination and presenting skills.  I have the test tomorrow and then it's off to Internal Medicine. 

In other news, I finally went to the other hospital and downloaded the case information for the patient who I want to present to my classmates.  I have a presentation in mid-April that I need to prepare.  Trying to get my rotations for fourth year all set up.  Our school's 4th year coordinator is apparently really bogged down with doing these, so I don't know how soon they will be out - I'm a bit anxious about getting the information out in time.  Hopefully it'll all work out and my rotations will fall into place without a problem.  Thank goodness UC Davis does an online application.  I should schedule my flight and hotel for my Step 2 exam - the part where we have to do 10 full patient visits in a row somewhere on the east coast.  Studying for the Step 2 written exam hasn't quite revved up, I'll need to get my butt on that.  This weekend I get a bit of a vacation, then it's back to work.