Next Steps...

The last day of fourth year/rotations was last Friday - my last two rotations were allergy/immunology and forensic pathology.  It was quite neat seeing how they track bullets through people and the various gross findings in freshly deceased persons.  At any rate, I'm finally done and I am looking forward to putting Touro behind me and moving onto better things, with my excessively high 300k debt following behind me.  We have our apartments in Davis and Redding secured, and soon I'll have to do some PALS training, computer training, ACLS, BLS, etc.  That won't be until June 19 though, so until then I get to relax and do some prep work for those things, and the wedding.  The wedding is the last hurdle - I'm half excited and half wishing it would just be over already, since we've been planning it for months and the Bora Bora honeymoon awaits us...  

Wish I had more to say.  I'm sure some of my experiences on the rotations are worth reporting but all I can think about is wanting to get away from Touro and start earning money.  I'm tired of just racking up debt in an overpriced institution (when you look at the national averages...) and standing in rooms while doctors and patients interact.  I'm tired of waiting and watching and want to start DOING.  Yes, it comes with responsibility, stress, and long hours, but I want to start moving forward in my life.  This is a big year in terms of moving forward, and I want to get on with it!  Graduation is June 2, tomorrow I'm picking up my regalia.  Soon...  soon...

Interviews: Done

Well, all is complete.  Finished all my interviews, am one week into vacation, and it has been a busy vacation indeed!  After getting my thank you notes all figured out, had a weekend in Monterey to take care of wedding vendor business (Florist, Cake, and Hair/Makeup).  We also have a guest for the month, and another guest coming next week.  It's nice to be busy with only fun things.  Ordered the Save-the-Dates, got the guest list finalized... just riding out the end of the month.  Things are pretty much going awesome, and I feel very confident that I will match at my top choice, and if not then my second choice, both in Sacramento.  I doubt Davis will rank me particularly high, and after that one then Redding and Modesto are perfectly feasible options.  

Not too sure what else to update - I feel very fortunate compared to some of my classmates.  I know what I want, I'm competitive in the field that I want, I'm compatible with the field I want...  Compared to others who don't know what they want or aren't competitive for what they think they want.  I'll probably hold off on any more updates to this blog until I start my Neurology rotation in January, and then the Emergency Department rotation mid-January.

Change in Reception...

Well, this was certainly a little different than the previous places I went to. Today's interview day went okay. It was mostly negative, though. First off, none of the residents who were showing us around seemed to know what they were doing. The day started off with a tour, instead of an orientation like all my previous days had started, so we didn't even have an agenda. The person giving the tour was an intern resident, who has only been with the program since July and hasn't even worked in all the hospital departments yet. Usually it's a 2nd or 3rd year resident who does the tours. They also were frank about telling us some of the negatives about the program. When we got back, first I was with a faculty member and she seemed to start off a little colder but she warmed up gradually. Went over my application, I got a bit of a skeptical vibe from her, but I kinda shrugged it off, it didn't seem to be a big deal. After that interview, I was with a current resident who was pretty nice and seemed to like me fine. He even told me a little about the criteria for ranking people, which he probably shouldn't have, and said that being a Spanish speaker, interested in OB/GYN, underserved and rural medicine, etc. are all part of their checklist for whether to rank someone or not. 

After that came the program director (PD). I was willing to give him the benefit of the doubt at first, but he didn't seem particularly warm or excited about me. Certainly not like the Sutter had. Sutter probably knew I had genuine interest in them based on me doing the sub-internship, and I had spent a month with them being nothing but nice and pleasant and enthusiastic. I basically felt like the PD here started the interview with the assumption that I was a lying game-player trying to dupe them into thinking I wanted to be in their program so they would rank me highly. For one, he didn't seem enthusiastic or happy at all when I said (TRUE) stuff that matched their mission goals. I DO want to work with Spanish speaking patients, I DO want to have full-spectrum experience and know what resources are available to uninsured patients in California. I don't want to do nothing but OB/GYN but I'd like to be able to handle my primary patients when they get pregnant instead of sending them off to a "specialist".  He basically told me not to rank them unless I really wanted the program, and whenever I said what I liked about the program he seemed entirely nonplussed and just reiterated his previous statements. He even went so far as to say that it's "better to scramble for a residency than match at a place that is just a backup." 

Also, mid-interview, he asked about my Spanish experience and then proceeded to say (in MEXICAN Spanish) "How about we chat in Spanish for a bit?" At first I was thrown off because he used the Mexican-Spanish word for chat instead of the more common verbs like hablar or charlar. I never use the word he used, but based on the context of the rest of the sentence I figured it out after a second of confusion. I asked what he would like to discuss and he said tell me about a patient I saw in the past year. So I start telling him about a patient, and I wanted go on, since I was starting to get going better, and he basically cut me off and played it off like he just likes hearing peoples' accents. First off, part of me feels like he intentionally used the Mexican parlance to make it more challenging. Second, he didn't even let me talk long enough to hear much of an accent, OR let me get in the rhythm of it. He knows it's not my native language, and interviews are somewhat stressful even when you're a competitive semi-confident applicant. Obviously he was checking to make sure I didn't just lie all over my application.  I was expecting to run into someone who would want to speak Spanish with me as a subtle 'test', after all, they always say never to overestimate your language skills unless you can conduct the interview in Spanish.  It wasn't the fact that he tested me, but his skeptical expression and tone. I kind of wonder if it was because my personal statement seemed overly-tailored for their program - I only tailored the very last short paragraph, but the rest of the personal statement (the generic family medicine part) just so happens to perfectly suit their mission statement over the other programs a bit. My scores are also pretty competitive.  Maybe on paper it looks a little too good to be true for their program.

Either way, I had been starting to consider that the place might be nice to be at, if it came to it - it would definitely give me my Spanish experience, the residents all seemed pretty chill and nice, and the earlier faculty member I was interviewed by seemed nice and interesting.  Plus its location is pretty nice is near some nice places.  Ultimately, this program director's attitude was a complete turnoff, and the PD plays a pretty significant role in your residency training over the next three years.  I don't want to have to be around someone like him who treats me in such a judgmental manner and isn't even open to hear what I have to say. One of the other faculty members also attacked a 3rd year student from UCSF who was giving a talk about a global non-profit organization she started before medical school that was reducing maternal morbidity and mortality worldwide.  After we finished clapping and it was opened up for comments and questions, the first guy who raised his hand was this faculty member who essentially told her that some of their efforts were a waste of resources and time, and that they were going about it wrong.  Not a single word of encouragement.  A couple other people commended her after that initial commenter, and of course she took the initial criticisms in stride, but...I was upset because her accomplishments were honestly quite impressive.  

Two Interviews Left...

Well, two more days of GI left, and two interviews left.  I decided to cancel my Reno interview.  I've gotten good enough vibes from three of my top four programs, and two of my backup programs, that I don't really want to risk driving my two-wheel drive car into Reno in January when it would be at the bottom of my rank list anyway.  I am almost tempted to cancel the next two interviews, because I'm getting tired of interviews, the novelty has worn off, and these last two places are also at the bottom of my list.  However, one of the interviews is Thursday, and the next one is a week from Thursday.  They are coming up so soon that I might as well just do them.  

Currently on my GI rotation - mostly just trying to get through it.  I'm already tired of seeing colonoscopies.  They're interesting enough, but ... pretty brutal to watch and most of them are very routine.  Nice preceptor, very glad I'm only spending two weeks doing this.  Really more like one week considering the Thanksgiving vacation and my two interview days.  After this, it's a month off!

On another note, got my wedding dress ordered, got my car repaired (one more expensive repair coming up but I'll do that after I get my next loan disbursement), and have all of December off during which I get to visit my maid of honor in Seattle, have two friends stay over, and celebrate two Christmases.  Oh yeah, and my Birthday.  The guy at the Pinkberry Frozen Yogurt place today guessed that I was turning twenty - off by about 6 years.  Glad I still pass for a college kid in a college town.  I would think it would be even more obvious when you're surrounded by people who actually are younger than you.  Also going down to Monterey soon for a few days to check out wedding venues, and next year Mom's taking us to Hawaii for a few days.  All-in-all, 4th year is winding down to be pretty good, and I feel like when you really set your mind to something, anything can happen...

Probably because today's interview felt like it went really well.  Maybe I was just overconfident or over-comfortable  but I feel like I got really good vibes from them.  Like Kit always says, "Be nice to the administrative people, because they make a big difference and are usually unappreciated."  Very true.  When I did my sub-internship at this place (my number one choice for residency), I tended to go through the back entrance since the front included the waiting room.  The back entrance I had to ring the bell every day and they were always smiling and very happy to get up and open the door for me - I even apologized most of the time, saying I wish there were some easier ways to get through, and started using the other door after a while.  I always chatted with them, smiled a lot, showed my appreciation.  Today I feel like they not only remembered and liked me from before, but I felt like they tried to put the spotlight more on me a few times, and I feel like they even might have talked a little to the program director.  They definitely made an effort to remind her that I had done a sub-internship at the site, and when she came back while I was the only one sitting in the room (others had gone to their scheduled interviews, I was on a scheduled "break") she said she had looked over my application just then and talked to me in a kind of informal interview.  Just the level of comfort from knowing the facility and all the residents was really encouraging and confidence boosting.  

Also, when they're saying to the interview group "We allowed to tell you that you're a shoo-in for the program," I couldn't help but feel like they were half-directing it at me.  I don't know.  They aren't allowed to tell us this stuff because if they do, then students get the wrong idea, and cancel their other interviews and put all their eggs in one basket when there are no guarantees that the program plans to follow through.  It's all part of the game I suppose.  

On another note, we toured the Davis maternity facilities and when I graduate, it would be pretty sweet to deliver my first baby there.  They have one of the lowest C-section rates in the country, have facilities to allow you to be in a pool for labor or for water birth deliveries... it looks pretty dang awesome.  You can also connect your music player up to the sound system in the rooms.  I have 4 years or so to figure it out, so we shall see.  But I've got my eyes set on that location - not to mention it's only 10 minutes from where I live now.  That would be pretty awesome.

Sub Internship - Week 3

Well, I know I haven't been updating much - it's been busy.  A lot of fun stuff going on - seeing all kinds of patients, getting to know the residents and faculty... it's really enjoyable.  I had almost forgotten how much I enjoyed family medicine - there are so many things you get to do in family medicine that you can't do in other fields of medicine.  A day could involve diagnosing a patient with anorexia, managing a patient with depression, removing a sebaceous cyst, performing maneuvers to treat a patient's vertigo, putting a cast on a 10 year old boy, identifying a rash and prescribing antibiotics to prevent future heart complications, managing a patient with hypertension + diabetes + chronic kidney disease + depression + foot ulcers + macular degeneration, managing a patient with sinusitis, counseling a patient on weight loss, removing an ingrown toenail, identifying a urinary tract infection... and so on.

Essentially any medical problem a patient has, they go to you first.  So much fun.  I'm at the point where I know enough that sometimes it feels like I really have the answers.  There have been many encounters that would be blog-worthy in these past weeks, I just don't know where to start.  A woman at 37 weeks gestation who has gestational diabetes, who also just developed symptomatic gallstones, who has an OB/GYN physician who seems indifferent to the fact her pregnancy is one problem away from becoming an emergency surgery?  Breaking the news to a young skinny girl that she has dieted to the point that she isn't having periods and needs to gain more weight when that's the last thing she wants?  A man with crippling chronic pain from an accident years ago who is allergic to morphine?  

The residents have been great, the attendings have all been great, I feel like I fit in really well.  I love the area, the city, our new place.  I really hope I get into this program.  

Currently my tally is 8 interviews scheduled out of 11 programs I applied to.  I think I'll get an interview with Davis, and I am still hoping for at least one more interview offer.  I'm not holding my breath for one of the programs.  I'm kind of looking forward to interviews as well - two places are covering my lodging.  One of them is letting me stay with a resident, and another is paying for my hotel room.  Tomorrow hopefully I can relax a bit.  I need to get back on my exercise regimen but I strained my calf muscle two weeks ago and it still hurts really bad and I don't want to be impatient and hurt it even more.  After next week I start Pediatric Psychiatry - should be nice.

Sub-Internship Day 1

Things are going well so far - they have EPIC electronic medical records and I have full access, so I have started making my own note forms and am getting on great with everyone I've met.  To make things better, before the end of the day I had an interview request from Merced, called Salinas and confirmed my interview for end of November, and the coordinator I met this morning (at place I am currently doing my sub-internship) sent me an e-mail requesting/confirming an interview date!  So now I have two interviews scheduled, and two I'm waiting for official date scheduling, but 4/11 within 1 week of applying ain't bad!  

I also like my preceptor and hope to get along with everyone super well.  I'm just trying to remember to smile as much as humanly possible, without it looking inhuman.  They seem to think my patient presentations are pretty decent too, even though right now I feel like I'm so scatterbrained.  It's been a LONG time since I did any rotations in a clinic, so my outpatient presentation skills are really rusty.  Shouldn't be long before I'm back in the swing of things, but until then, it's a slightly rocky start.  I'm definitely glad I'd touched base with a couple current residents - it's nice to see familiar faces, who all seem encouraging. 

At any rate, I think I'm going to go and read up on some stuff I saw today and then do some pleasure-reading.  

ICU

Well I just finished a week on ICU.  Definitely more intense than previous rotations, but getting a lot of experience and trying as hard as possible to be a fast learner.  So many sick patients.  Many vegetable or "anoxic encephalopathic" patients, from quadriplegics with huge ulcers who need to get a trachostomy because of recurrent pneumonia, to people with interstitial lung disease who have been in and out of the hospital for many years and just start taking a turn for the worse.  I've assisted in several intubations and central line placements.  Central line placements feel the most natural - intubations are unpleasant.  My second one was aspirating "coffee ground emesis" the entire time and we are still not sure where her upper GI bleed is.  

This weekend I have one day free, so I'll be hopefully using it to work on my personal statement for residency and setting up my applications online.  Also hopefully spend some time with the fiance.  We get a few hours every evening but now we are both working until essentially 8pm each day.  At least we are both busy.  

I don't know that I could work in a field where most of the people do not get better, or they get slightly better and then you see them a month or two later nearly brain-dead with family refusing to accept that this might be the time they don't come back.  It's hard hearing the explanations for patients who are vegetables, where patients' families will swear that they were looking at them, or had tears coming down their face, or squeezed their hand.  Bad news every day is very depressing.  We actually had a family that was rather quick about it today - Three hours after we intubated an old woman who had severe pneumonia and many other comorbidities, her family arrived to remove it and let her die in peace.  This compared to three others on the ward which will probably not get better.  

Anyway, another three weeks of this.  I have heard that the preceptor next week (they alternate weeks) is easier than my current one, which is fine since it might be nice to have a reprieve.  It's funny, my current preceptor talks about how he doesn't want to be anyone's boss, so he joined a physician group, would never join Kaiser because they own your life, and yet he is constantly taking calls about patients, staying beyond 12 hour days, etc.  I find it hard to believe he has more of a life than a lot of the doctors I talked to at Kaiser, where they can actually leave a lot of their work at work.  We'll see - he's given me more to think about as far as potential work environments.  I will definitely have to thoroughly investigate the different options for practice.  Short of solo practice.  

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.  

COMLEX PE

Well, today I had the COMLEX PE exam - it's a pass/fail exam where you have to have 12 standardized patient visits and then do a write-up.  You have 14 minutes to see the patient, and 9 minutes to do the write-up.  For DOs it is only offered on the east coast in Pennsylvania, so of course, off to Pennsylvania I had to go.  So jetlagged...  Anyhow, things were starting out fine, ironed my white coat, did some spot cleaning, looked great.  Then when I put it on after carrying it over one arm to the test center, I realize I got blood on it somehow - I nicked my knuckle somehow.  So I had to cover it up with something, first I just had clear tape, next I had an actual white paper cover, which was better.  Hopefully it won't count against me too much in the exam - I think it'll all average out okay, but it was really disappointing.  

As far as the patient encounters, they all went about as expected - and I was surprised that I never really found myself running out of time for either the visit or the write-up.  I feel like I always got through it, was able to ask them if they had any questions or concerns or if I can help them with anything else, etc.  Super exhausted though.  Treated myself to a nice dinner, and now just debating how much sleep I want to try to get before my 6am flight.  This time we get to change flights in Chicago, but at least the second leg will have Wi-Fi, so I won't be as bored out of my mind as I was for the first flight.  My stomach has felt funky the whole time I've been here, so I'm looking forward to getting back to my normal food.

Another bummer today was I got an email saying I didn't get a rotation spot at one of the programs I wanted to do a sub-Internship at.  It sucks that they took so long to figure that out because now I can't really make any other arrangements - I have to just scrounge for some other rotation.  Hopefully our department at school will be working through rotation requests a lot faster now that they got some extra people to take care of student health.  

As far as Psychiatry, it went well overall.  The preceptor was great, the patients were interesting, and the hours were very reasonable.  I was not too happy that I had to cut a lot of the days out because of mandatory lectures at school and this trip to take the exam, but at least I made the most of my time there.  The end-of-rotation exam is Friday and then I'm on vacation for two weeks.  Got some nice activities queued up, and I need to start seriously planning my wedding.  

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!

Last Day of Internal Medicine

It's a shame that I have to leave Internal Medicine right when it started getting enjoyable - mostly because of the preceptor.  I walked the team through a New England Journal of Medicine case and my preceptor and one of the interns commended me on my presentation of it.  My preceptor also seemed pretty impressed with my patient presentations, so that was reassuring.  I also started getting into the habit of picking up patients who had Hispanic-sounding names, since most of the people on the team speak little-no Spanish and it's a good opportunity to make a difference and look impressive.  Today we were shorter on prep time and I actually was the only person who had seen this one patient (Spanish-speaking) at the time we presented, so that was pretty cool.  My preceptor then gave me the rest of the day off to study - I ended up mostly sleeping because the last two days I've gotten about 3-4 hours of sleep each night.  

Tomorrow I have my Internal Medicine exam - going to go through practice questions.  As long as I pass it that's all I need.  I also got a "Medical Spanish made Ridiculously Simple" because while I speak Spanish decently, if I want to use it as a bullet point on my CV I'd rather have it be a little more honed.  Especially since my rotation in September at my #1 spot for possible residency will have me working with a preceptor who likes to emphasize Spanish-speaking patients and I suspect he is not a native speaker either.  

Anyhow, this weekend will be a bit relaxing - Friday and Saturday just for me and the boyfriend, then going out on Sunday to a dim sum brunch in SF with my best friend who will be leaving for Seattle in a couple short weeks for a new job... then possibly watching the eclipse with my family.  Next week I start Psychiatry - last one for a week and then, as luck would have it, I will have a 2 week vacation.  I had intended to fill this spot with Radiology, but the doctor could only take me for the first two weeks of July, not from mid June-mid July as I had wanted.  More time to study at least!  

Inpatient Medicine - Finally

Well, I have finally started my inpatient medicine internal medicine rotation at a teaching hospital.  The first day was pretty exciting - we rounded on patients, I got to know my team, we hung out in the emergency department and admitted people, ran to catch a code blue, etc.  It had a very "Scrubs in India" feeling to it because the residents and the attending are all from India (except one woman from Bosnia?).  They are nice, but one challenge is they have very thick accents and are kind of clique-y.  One of them in particular has a very thick accent that I have a lot of trouble understanding, and I know he has trouble enunciating so I feel a little bad asking him to repeat himself all the time.  They all talk softly too, mumbling, so it is hard to tell what they are discussing unless I am super close.  

It's gotten a bit more negative as time goes on - first day I thought things were going to be good: I would follow a patient, the attending told me to pick a patient and a topic to research, and then I'd discuss it with them and present the patient.  My first day I wanted to follow a patient with COPD, but then she was going to be transferred to ICU where we don't really round or follow patients.  This was after I had already done a writeup and was preparing on that topic.  It was then suggested that I follow another patient - so I picked a man with liver cirrhosis and varices.  So that's two writeups and two topics I needed to look over that night, on the off-chance we went to the ICU.  When I finally try to present the next day, the attending corrects me on the order in which I was giving information, the standard form that were taught and how I've been doing it over the last year with no complaints from any of my preceptors.  After I do half a presentation,  then the resident I was working with filled in the physical exam portion (which was essentially what I would have said, minus two small findings), and another resident presented the next patient.  That person did the EXACT format of presentation that I did, but of course without being called on it.

To make things a bit worse, today the resident who has a thick accent wanted me to look up some information - how a medicine is connected to a condition.  I figured it was a "this is a good topic to know, look it up and we'll discuss it" type task, similar to what attendings have done in the past, and he didn't give me any indication it was otherwise.  After a 30 minute search on my usual online textbooks, all reputable sources like Harrison's and Current Medical Dx and Tx, I couldn't find anything linking the two.  I come back, told them what I found out about the topic and medication, and they tell me to just google it or search on pubmed.  I got pretty annoyed because I didn't know he was just scouting possibilities for research projects and there WASN'T an established link between the two things.  I go back to pubmed, which they spelled out to me as if I had no clue what it was even though I've used it a million times, and I still couldn't find a single article linking the two conditions.  Everything was consistent with what I had previously reported.  

Ultimately I found an article about use for the medication in the condition in general (which I had already described) and there was another medication he was curious about so I found a couple token articles about that, but I left in a rather sour mood after having to do almost 2 hours of busywork for no real payoff and reviewing an esoteric topic that I already knew.  

The topic I'm reading up on for the attending currently, bacterial meningitis, was something I read through yesterday - I must have read through 3 different full-length UpToDate articles, and where I thought there were holes in my knowledge I continued to investigate.  Wrote everything out, went and checked out the pertinent sections in my review books, and today he still wanted to give me more time because he said UpToDate isn't the best source and kept asking about random textbooks that they used back in India.  At least he approves of Harrison's and CMDT, but I read over the meningitis information in those texts, and it was verbatim what I found in the UTD articles, and actually was less detailed.  I understand that UTD is a quick reference and half the articles are short and to the point, but I went for the full-length meaty articles.  

Long story short: Feels like they underestimate how much I know without even testing me, or letting me go on when I try to engage in a discussion.  

Plus sides: There is night call twice a week, 8pm to 8am, and then morning rounds, usually get off around 11am the next day - meaning I get to sleep in the day before, study, eat at home, and then spend the night in the hospital, knowing I have the entire next day off.  Essentially reduces my number of shifts by two.  I am not sure if I have weekend duty, but if I can get by with just 3 shifts per week, I'll be pretty stoked.  

As far as rotations go, I got sub-internship at the program I plan to rank #1 - the guy who called was I think a rank higher than the lady who actually does the coordinating and he went over my application.  He commended my USMLE Step 1 score and grades, and liked my personal statement - tried to connect a bit with some things he's done as well.  It almost felt like an interview - which, in a sense, it was, but it felt almost like a residency-screening interview.  I'll assume that his positive feedback about my application indicates I have a good chance of getting an interview for the residency program (provided I don't screw up my boards and rotations between now and then).  

Called a few more places today, starting to get a few more things on board - I'm going to see about doing some easy rotations while studying for my Step 2's so that I can have more vacation left over for a potential trip to Europe.  I think I have ER and Surgery in the bag, and ICU and a Medicine Subspecialties should be easy enough to arrange since Touro has a few exclusive arrangements.  Still waiting on Davis to get back to me, but I'm not really holding my breath too much for them.  Also waiting on another program out there, but they just updated me that they're looking over the application and I should hear from them any day now.

Perhaps time to take a nap and then read up on more meningitis and do some practice questions.......

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.

Pediatrics, Week 5

Okay, it's been a while since I updated - various things have happened - boyfriend had surgery, we had a friend visit and stay with us for a week, oh yeah, and I got a really bad cold after not being sick with anything of any kind for over a year.  Anyhow, pediatrics is going well, even if it is still pretty boring by my standards.  I like patients that can actually talk to you, and the majority of our visits seem to either be under 24 month well checks or kids with runny noses and ear infections.  Occasionally we get older kids, ADHD kids, and the like.  I got to hang out with a pediatric cardiologist, a pediatric behavioralist, and a pediatric endocrinologist.  I'll stick to the highlights...

As far as my preceptor goes, he seems to think I'm pretty smart and capable - he constantly comments that I am really good at writing up history and physical notes and write really quickly and well.  Basically I have them done at Step 2 Board Physical speed - get in the room, start writing, and by the time I'm out I have the history written and am halfway through the physical, already having discussed the assessment and plan with the patient to some degree.  I also have Step 1 USMLE studying to thank for having a reputation now as a medical dictionary.  It's funny, but I'm glad he thinks highly of me.  Even though I'm not particularly interested in pediatrics, I'm considering asking him for a letter of recommendation - simply because he would probably write a very complimentary one and has said on many occasions that I will be a great primary care doctor.

The only real complaint I have about him is that he won't let me interview Spanish-speaking patients, he insists on us just getting an interpreter and not letting me have a try at it.  I'm not sure why, I suspect it's for medical-legal reasons, perhaps he doesn't want to end up relying on what I say and then if something goes wrong then he can't refer back to interpreter #### who misinterpreted for him.

Still going to my didactic sessions, been mostly working on getting my applications together for my year 4 rotations.  I found several places I want to go for - my list of possible good places has increased from 2-3 to 3-4, and my list of total feasible options from 4 to a bit over 10.  It helps that I am going for family medicine, which is more receptive to DO students.

Next month around this time I will have to do case presentation - I'm planning on doing it on that young homeless woman who came in with abscesses in her muscles that we thought at first was meningitis or endocarditis.  It was a really interesting case and is a good way to talk about diagnosing meningitis, which is an important thing to understand.

Good news: I also got back my board exam score and not only did I pass, but I scored the average for all 4th years who go into family medicine residencies.  While it is just barely over the cutoff for one of the programs in Sacramento that I wanted, I can do better on my Step 2 and hopefully that cutoff was more for COMLEX scores and not USMLE.  Either way, I passed that and am essentially caught up to where I should be.  Now to study for Step 2 and get my fourth year figured out.

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.