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.  

Applying for Residency

Well, some of you may see this around the time it is posted, others may not see it until far later - why?  Residency applications.  It is a well-known fact in this world of technology and the internet that potential employers and programs "google" their applicants to see if they have any unsavory activities.  Not that this blog or any of my other interests are unsavory, because honestly they are not, but I don't know that I want any program directors perusing my blog entries and overanalyzing any hints of cynicism or detachment I may portray in them.  As always, this blog is an outlet for my medical experiences, and lets me take a step back from the nitty gritty of everything.  

I shall now continue.

A few days ago, I finished tailoring all my personal statements for the family medicine programs I have decided to apply for.  In total, I have selected 11.  I was originally only choosing 10, but my adviser encouraged me to go higher, so I added on a program in Reno, NV.  We are encouraged to send tailored applications, according to a book I have about "Acing the Match."  Supposedly, programs do not expect it, but when they see a tailored personal statement, they pay much closer attention to you.  Combine that with the fact that my personal statement pretty much screams "Amazing Family Medicine resident," and I have a decent application.  Board scores are about average for those applying, but for super clinical medicine, numbers aren't really the most important thing, and the interview is their number one criteria for ranking applicants.

That said, I sent out all my applications, each with their tailored application, on Monday.  Our Dean's letter is another major criteria they use to determine who they invite for interviews, as most programs only interview 100-250 students for about 8-16 spots, so I wasn't expecting to get much as far as responses for another couple weeks.  Much to my surprise, today I got not one, but TWO interview invites.  Super exciting!  Kind of a "This is happening too fast!" feeling.  Two other programs notified me that the received my application and will be reviewing it over the next couple weeks - one had me list my interview date preferences in case they choose to invite me for an interview after reviewing my completed application, including the Dean's letter.  Dean's letter should go out around the beginning of October, so I should start hearing from a lot more programs then.  Having two interviews already in the works is really exciting, especially when one is a program I thought would be more difficult to get an interview at, and one of the programs is in my top 4 choices.  Things are looking good.

On the other hand, next week I start my sub-internship at Sutter Sacramento, which is my tentative first choice residency program.  I am not sure whether it will still be my first choice after interviewing at a bunch of places, but we shall see.  It is the most compatible and geographically convenient of the programs I have looked at.  If I get interviews at the 10 California programs, I may just withdraw my application to the Nevada program, since they mostly accept MD students from the Caribbean, Nevada students, and DO students, suggesting their program is not of very high caliber.  I also didn't get a very strong impression from their website, short of them offering wilderness medicine.  

The next couple weeks will be exciting to see who is interested in me, and how many choices I will have.  The thing I don't know is whether they have actually read my personal statement or if these interview invitations are based on my COMLEX/USMLE scores.  I have a feeling they must have read my personal statements, because my scores, as I said, were around the average for successful family medicine applicants. I really hope I get an interview at every place I listed, because that would make me feel a lot more comfortable about the match, come March.  Time to drink in celebration!

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 Step 2 Written Exam - Attempt 1

So, yesterday I went to take my COMLEX Step 2 exam.  I felt pretty prepared, got through the first four sections without any real hangups.  Then came the after lunch portion.  When I returned, suddenly I only had 25 minutes left!  I was confused because the first section showed the cumulative time for all four sections at once, so at the beginning I had 3 hours 59 minutes, but then when I started section four of eight, I only had 25 minutes.  I thought maybe they just changed the format for some reason, rushed through as best I could, and the time ran out of course.  At that point, the entire test crashed.  When the Prometric called to see what was going on, the line was busy due to 'extremely high queue for service regarding the COMLEX' so... turns out the test crashed nationwide.  

The most annoying part was having to drive out there to take the test through rush hour traffic - took me almost an hour and a half.  On the plus side, I basically got a trial run of the actual COMLEX Step 2, so that was kinda nice.  I also get more study time.  No clue when I'll schedule the actual test, though.  I'd prefer to do it on a weekend, so maybe I can get next Sunday or something... if not, then who knows.  I also need to reschedule my USMLE - I wanted a full month to study for that between the two tests. 

That's the latest.  Next week I'm starting radiology for two weeks, it's supposed to be pretty relaxing.  After that is neurology.  Then ICU, which should be rigorous.  Then eventually moving to Davis, CA.

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.