Latest Event Updates
So, in the midst of all the madness sweeping through the world, I’ve just finished the Obstetrics and Gynecology rotation — I finished my first rotation. I received some of my feedback from the interns, residents, and attendings; I was told that I made it to honors level if my shelf grade pans out (or a high pass at worse case).
Schedule and Experience
It was a 6-week rotation, 3-weeks on Gynecology and 3-weeks on Obstetrics. My hours of patient care, not counting charting, ranged from 12-17 hours a day, a typical day was around 14 hours with charting. After 6 weeks, I’ve seen and interacted with about 170 patients. Usually, once a week I had call. Interspersed within the rotations are ambulatory clinics. Once a week we had didactic days (lots of workshops about patient care and disease management), conferences, and one M&M meeting.
- Student run clinic (we saw patients, diagnosed, and formulated treatment to be signed off by a physician or NP)
- Clinic for high risk pregnancies (gestational diabetes, mothers with risk of heart failure, etc)
- Substance abuse pregnancies (methadone, heroine, cocaine, etc)
- Gynecological Oncology
- Urology/Gynecology (usually pelvic floor dysfunction)
By the end of ambulatory Ob/Gyn, you’ll be a master of unsavory vaginal secretions, and you’ll feel unusually comfortable talking to women about their nether-regions. I’ve heard males have it rough, because some women don’t want their Gynecology care from them. Sure, there were a few patients who didn’t want me to do their vaginal exam. But, for the most part, after about two minutes of us talking and building up a relationship most women were very comfortable with me asking them questions and performing their exam. I only had one awkward experience that made me very happy I had a chaperone in the room. There was also an opportunity to an abortion. I was warned that seeing the fetus (at 10 weeks they’re rather human-like in form) could be traumatizing. After the abortion, you have to take the products of the abortion and identify the fetal parts: arms, legs, trunk, and head. Although, it may offend some people, this was actually less remarkable than I expected. The only thing that bothered me was the intense sucking sound during the procedure. On the other side of the spectrum, I’ll never forget using sonography to allow the mom to hear her baby’s heart beat for the first time — though, I’m not sure who was more giddy her or I, because it was my first time to do it.
Prior to this rotation, I was rather ignorant to the fact that gynecology is principally a surgical specialty. As such, you end up seeing a lot of procedures. In our program, you just signed up for whatever surgery you wanted to see. You’d follow that patient throughout their stay: do post-op checks, get to know their nurse, pre-round on them in the morning, present them during rounds, and make the occasional friendly visit just to see how they’re doing. When there’s downtime, you can study if you want, because it’s easier to remember a person than anything else I prefer to read up on the patient I have.
Pre-rounding: everyday, there are rounds, the most succinct description is people get together and talk about patients. Prior to rounds, because you’re expected to be an expert on your patient, you may (or must) pre-round on your patients. A lot of times, this involves getting in a little earlier to talk to the nurse that was with the patient overnight, waking the patient up to hear their subjective experience, doing a physical (including checking their wound healing, urine output, and overall disposition). Without a doubt, a lot of your conversation with the patient will revolve around you being excited that the patient had a bowel movement or passed gas. My biggest advice for pre-rounding is to get there very early, earlier the better, have your note down and practice it with your Sub-I or resident, then use your polished note as the basis of your presentation for rounds.
Surgeries: we could sign up for any surgery we wanted, as it was ‘required’ that a medical student is present for every surgery. Most people signed up for a variety of surgeries, hoping to never see the same procedure twice. Personally, after working with several surgeons, I signed up for the same surgeon repeatedly. This worked out for me, because there was a trust progression: first I was allowed to scrub in and successfully not touch anything, then I was allowed to assist in retraction, then I was allowed to suction and place a few stitches, and by the end allowed to diddle around with the laparoscope and help close with subcutaneous stitching. You learn a lot during the surgery, a lot of it applies to the shelf exam and to clinic (I’ll never forget that fibroid are a common cause of bleeding after my scrubs were soaked in blood during a surgery from the fibroid, even with the gown protection). My biggest advice for surgery, “Unless you know exactly what you’re doing, resist the urge to help”.
This is exactly what you imagine it’ll be: pregnant moms, babies being flung into the cold hard world, and lots of fluids splattering on you. Child birth, at least the result, is rather beautiful. However, it shouldn’t be forgotten that for most women it’s the most dangerous and precarious event in their life. This is reinforced by the fact that in many countries, without modern facilities, labor and delvery is still one of the leading causes of death and morbidity.
Labor and Delivery: now I’ve seen a few vaginal births, I’d almost feel like a war criminal if I got a women pregnant — shout out to all the ladies who take one for the team and keep humanity going. But, I digress. This part of the rotation requires a lot of you, few things will inspire you to read-up than having to answer questions from anxious parents about their progress into labor. Labor and delivery was a mixture of organized chaos, calm (time to chart), and extreme organized chaos. Here, I’ve learned a few things:
- Holding a woman’s hand during contractions is helpful, but beware of women with long nails that dig into your skin.
- Babies either stubbornly are delivered cm by cm or rocket out like a cannon ball, it’s hard to predict which it will be.
- During delivery most fathers are rather useless, but them being there is usually better than not.
- Delivering the placenta is your job, as the medical student, it’s actually rather easy if you follow instructions but if you screw it up then the patient may exsanguinate — follow instructions
- A lot of people tacitly assume you know what you’re talking about, even if you don’t, so try to know what you’re talking about.
- Every women who chooses to give birth is gambling her life and such owns their experience, whether that be the decision to refuse an epidural or to refuse a c-section.
- Always have gloves in your pockets and also know where to find sterile gloves in a hurry.
Cesarean section: c-sections get a lot of bad press. Some think of it as ‘unnatural’, or a procedure overused by mothers too inconvenienced by vaginal births. But, I’d wager that if you’re fervently against c-sections you’ve 1) never given birth, 2) if you have, things ended without complications for you so you have biased perceptions, or 3) judging people is just your past time. It is true that the rates c-sections have risen, but so have the indications for c-sections: mothers at risk of maternal or fetal demise and/or morbidity. Though, it is disappointing when a mother who didn’t want a c-section ends up needing an emergent one to save their and/or their baby’s life. C-sections are a messy procedure, because birthing is a messy process: you’ll be squirted by amniotic fluid (fancy way to say baby pee), covered in blood, and bathing in your own sweat (the ORs are heated for the comfort of the soon to be delivered baby). Besides that, I’ll never forget reaching into a patients abdomen to manually contract an incompetent uterus with my bare hands, a uterus that wouldn’t have had the power to give birth vaginally. Nor will I ever forget seeing the umbilical cord tied in a knot and hence the indication for the c-section.
The most rewarding experience of any means of delivery is seeing the baby be put with the mom for immediate skin-to-skin contact. I still find it amazing to see the look on each mothers’ exhausted face, that look of relief and proud joy.
Grades will come out in a few weeks, hope I get honors. But, above all else, I’m really pleased with the experience and opportunity I was afforded. It was the first time nurses asked me for orders of what to do next, the first time I was thanked by a patient who referred to me as her doctor even though I told her I’m a medical student repeatedly, and it was the first time I’ve felt marginally competent in the entirety of medical school.
Next, onto Pediatrics (I see germs in my future).
I took STEP 1 yesterday! My perpetual 6 weeks of misery is over, also called ISP, the dedicated time we get to study for the exam. Some say “ISP” stands for Intensive Study Period, but over time I’ve heard it be called a lot of other things that also start with I.S.P. — I won’t repeat them here, it’s a PG website, but you can use your imagination. Over the years, STEP 1 has morphed, from a test you simply need to pass to one you have to do well on. There are a lot of grandfathered clauses like that in medicine, take the MOC for instance (the bane of the modern US physician). I don’t really think most of what I learned for boards is particularly useful, or even practical: can’t tell you how many lectures we had where seasoned physicians would say, I’ve never seen this in my life, but the boards seems to love to ask you about it.
About the exam, I felt like a decent amount I knew cold, some I had to work it out on the fly, and the rest I had to narrow it down and make an educated guess. Upcoming 2nd years have asked what I used, here it is:
- FA with DIT as a companion – DIT was a game changer for me, I’m thinking about using it for STEP 2.
- Sketchy Medical – the micro section is strong. Not the fault of the company, but some pharm sections are really hit or miss because people who name pharm drugs hate you.
- Pathoma – efficient, and really sticks to teaching.
- Lippincott Pathology – great for pictures you’ve never seen before, and getting used to recognizing gnarly things.
- UWorld – for the question bank for pathophysiology explanations and what not. For what it’s worth, the test format looks exactly like UWorld; though there were a lot less buzz words to bring you to a snap decision.
- BRS Physiology/Behavioral Sciences – I only did the problems, whatever I missed I’d go back and read in detail.
List amended 5/18 to include Lippincott and BRS
My biggest tip is listen to those in the class above you, they’ll know what your school failed to emphasize. Then find out what works for you, I really don’t think I should dispensing advice, after all I won’t even get my score back for 6 to 8 weeks. And honestly, even if I did well, STEP 1 prep is an individual experience and the questions you get are sort of random. My only advice, if any, is to study broadly and to keep your confidence up. They’ve changed the test format, there’s about 280 questions now, and with breaks, it takes 8 hours to complete. I used all of my break time, something I didn’t do during any of my practice exams (5 hrs). I was fortunate to have classmates to talk to during break, so it made each break session a good decompression. I brought a thermos of double shot of cappuccino that I made at home, lunch for fat and protein, and plenty of sugary snacks to give me a kick. I also brought enough Advil to ruin my organs, I popped one in the morning because I woke up with an intense headache after not sleeping too well during the night. I woke up several times, and drifted between stress awake and stress light sleep –apparently, my classmates who were also there that morning, also had the same experience. I was never a great sleeper, so it was to be expected.
Now, I have to sort out my life, get my financial aid in order, and complete some mandatory tasks before orientation starts. Next week, we do EPIC training (again for me), another TB test, pick up our pagers, and get our hospital patches to have sewn onto our white coats. My first rotation sent our on-call schedules, I’m scheduled 5 days on call for my first rotation. Besides that, we’ll get training how what to do if we’re jabbed with a needle, and meet our clerkship directors. Thursday, I’m going on vacation to New York (I haven’t left Boston since medical school started, except for a trip to Maine).
Lastly, it was cool to see the whole generation of test takers there, people taking their MCAT, STEP 1, 2, and 3 all in one center. Though, the person who was the most chill was definitely the guy taking STEP 3. It was a nice reminder of how far we’ve come.
The second year of medical school is now over. It long in experience, but quick in retrospect. I mean, after all, when you’re tumbling down a hill it feels like it’s taking relatively forever. Medical school goes at an often unforgiving pace, whether you like it or not, for better or worse, and richer or poorer — there’s adages about medical school, one of them is, “The days are long, but the weeks are short”.
Third year orientation starts at the end of May, rotations then start the first week of June. In between then and now, I’ll have my board exam. It’ll be one of three: STEP 1 (in May), STEP 2 sometime next year, STEP 3 as a physician.
I’ve learned a lot in the last two years, and I look forward to learning more. It’s also time, as always, to work on paying things forward. I’m going to swing back to the medical campus, we have a high school mentoring program. It’s been sort of tough losing a Friday, as I usually don’t get much “scholastically” accomplished. But, honestly, I’m not sure if I’m really that great of a mentor. I’d argue that I may get more out of it than them, they bring a lot of “energy”. Today, we’ll do workshops on vital signs. Vitals are a lot more interesting when you know how to interpret and integrate the information. A few weeks ago, we took them up to the anatomy lab to show them hearts and brains. It’s easy to neglect how much you’ve learned, until you thoughtlessly put your gloved hands into the brain bucket, and can take Q & A from knowledge thirsty teenagers about pathophysiology.
Anyways, I came home after the exam to eat breakfast. Before exams, fight or flight kills my hunger, so I just nimble on something give my brain something to work with during the exam. This one exam was particularly stressful, it was the last one, and if I failed it I’d be re-taking this exam while studying for STEP 1. All went well, and I’m going to enjoy my little weekend off. I better get going, have to hope back on the train to get back to the medical campus!
I’m taking a posting hiatus, until mid-May, to focus my time either studying or enjoying the dwindling free time I have left.
Good luck to everyone applying to medical school. MS1 students, hang in there, you’re almost there!
Just 7 more days till the end of pre-clinical education. I’ll take my board exam (STEP 1) in May — it’s mandatory in our program that you take STEP 1 prior to starting 3rd year, regardless of your score.
STEP 1 is a big deal, I look forward that exam also being over. I started studying for it sometime in October of last year, or rather I started “priming” to study for it by doing board exam practice questions. Once school is over, we’ll have a dedicated study period to study.
This last spring break, coincidentally my last spring break of my life, was spent re-studying the first year of biochemistry and its relation to pathology in various diseases. For those 5-days during spring break, business days, I did a standard 9 AM – 6 PM schedule. Given yesterday, I started working on things at 8 AM and finally wrapped things up around midnight, I found the 9 to 6 schedule to be quite tolerable. After 6 PM, I took the rest of the night off (usually), I’ve started to learn how to play they keyboard. Since I moved from California, I left my hobbies behind, including music. I sort of played the guitar, so while on vacation, I thought I might as well be terrible on the keyboard as well. My days were wrought with biochemical pathways, and my satiety was filled in the night by “music” time. During my actual dedicated board studying period, I hope to maintain some type of balance.
Today, as posted above, our 3rd year schedules were given to us. Although we put in our preference, it was more or less a lottery system and some black box algorithms that decided our schedule. In general, we get the latest cutting edge pager technology (a 90’s motorola), our “work” week is capped at 80 hours per week, some nights on call, a few 24/hr shifts here and there — as you might deduce, not all rotations are built like this. No matter the schedule, we get a dashing pager as a consolation prize. I’m not too broken up about my schedule, mostly because I still feel humble to be allowed to do this type of stuff, but also because I got a lot of the important things I wanted:
- Away rotations aren’t too crazy – I have several away rotations, but only one of them is a journey. My farthest one is about 1.5-2hr (one-way) public transit ride away from my home, and I don’t own a car (45-55 min drive as estimated by Google Maps), and it’s likely the other person on my rotation doesn’t have a car either. Should be fun.
- I got Ob/Gyn first, I’m both nervous and excited. We were told that at our site, there’s a good chance that every student will get to deliver a baby at least once. That’s pretty crazy. The rotation will have a mixture of birth, prenatal care, and surgery. The schedule will be rather hectic but the work rewarding. I wanted to just jump straight into the medical fire, so I got what I wanted there.
- The rest of my rotations are either at the medical campus I attend or somewhere not too far.
- I don’t need to do my traveling away rotations during the winter time! Last year, we got about 10-feet (nearly 3-meters) of snow, as a city we likely weren’t ready for 8-feet of it, and so transportation came to a dead stop.
- I get to do some work at the VA. Sometime last year, I went to the VA for a nursing shadowing program. The VA gets a lot of flack in the press, but not all are created equal, and bad press doesn’t affect their dedicated to patient care (even if not adequately supported). Again, the nursing staff was awesome!
- For internal medicine, my finale, I’ll get to revisit the same cardiology wards I spent time in for the last several months. I also look forward to the other departments I’ll rotate through along the way. And finally, although I didn’t plan it, it’s sort of fortuitous that I have internal medicine last, because that’s around the time I need to take STEP 2 (the other part of my board exam), it’ll be a good refresher.
It wasn’t really all that long ago that I was drowning in uncertainty about my life. I’ve had many jobs during college, and after, some of them even “required a degree”. So, I look forward to going back to work. I presume, just like the rest of the path to medicine, they’ll be a lot of ups and downs. I’m sure I’ll have great days and terrible days as a 3rd year, as I repeatedly learn by making mistakes. How else would we learn?
I look forward to what’s ahead, I’ll keep you updated!
If you have any question, feel free to ask in the comments or by email at firstname.lastname@example.org
So, I’m still re-arranging the blog around in attempts to make it easier to navigate. But as things pile up, my board exam is coming up, courses, and random things I took on, so it’s going to take a while to get things how I’d like them [here]. I am actually on vacation, and I thought I’d do some background editing here. But, instead the instinct to survive took over, and I’m doing some board review (biochemistry, yay!). However, as people are applying soon and you may be one of them, thus I thought it’d be helpful to just gather-up some articles I wrote:
Medical School Admissions Guide – if you take two things away from this whole page, 1) apply early to medical school and 2) buy the Medical School Admissions Guide access for your application year!
Personal Statement Drafting and Planning Phase
Personal Statement Editing Phase
Example Personal Statement
Mine. – Sorry, I do have a trove of personal statements on my hard drive, but I only have permission to really put my own personal statement up. If I edited your personal statement, and you’d like you’re to go up here too just let me know.
Medical School Application
Primary Application Samples (mine)
Work Activities Section of Application – especially important for nontraditional applicants!
Medical School Interviews
My Limited Interview Experience – went on 5 interviews [across the country], declined a couple mostly due to budget constraints.
Elevator Speeches – optional read
Good luck and Best Wishes!
It’s well into February, many premeds have just taken (and are starting to receive their scores), physician interns are well on their way to transitioning to their “resident” status, 4th year medical students are out on their residency match game, 3rd year students have been kidnapped by their clerkships, 2nd year medical students across the country are starting to (or have) select their clinical rotations for (3rd year) clerkship, 1st year students are completing their “twelve labors“, and premedical students are fueling the fire for the next generation of physicians — some have just received their MCAT score, either way it went, congratulations because it shows commitment it’s a big deal to have the guts to sit for it. What about attendings? Well, they’re attendings, so they’re off being badasses and wearing sunglasses somewhere, long white coats flapping heroically in the wind all the while.
Where am I in this spiral towards doctoring? Well, in 30-some days, I’ll finish the 2nd year of medical school and have already chosen the preference for my rotation order:
- FAMILY MED
- ELECTIVE – RADIOLOGY
All the rotations above are mandatory, with the exception of the one marked elective i.e. Radiology. We had a choice between emergency medicine, radiology, or time for research work. At this point in time, I’ve conducted two cardiology department projects; one of the projects the PI wants to publish and I was invited to be a co-author. I’m pretty excited for this, when I was an undergrad I completed research projects before, and have done a few conferences here and there, but I’ve yet to publish a manuscript. The great news is that the second project, a pilot, secured our team an appreciable grant to develop our project. Unfortunately, my PI is also leaving to another institution as they’re interested in his work, he’s been trying to coax me to follow him their for residency (more on that at another time). There was another lab I was considering (heart amyloidosis, we’re a center for its treatment), but at the advice of some physicians I’ve decided to use my elective for something more “clinical”. This elective I’ve decided to take radiology, the next year I’ll probably opt for emergency if given the opportunity.
As a first year student, I still remember shadowing the trauma team. Well, it started off as shadowing, until we got slammed and I started taking histories (first month of medical school). A young lady had a likely pelvis crush injury, and we weren’t sure if she had perforated any bowel nor if she could walk. A lot of things happened that night, at some point I was sent up with the residents for a consult with radiology on the crush patient. When we were invited into the darkened room filled with huge monitors, I saw not only the scans from our patient but many others. I saw the difference in knowledge between myself and the doctors, the resident and their attendings. I think that was the first time I relieved how important radiology was. I’m not really aiming to be a radiologist, but I do want to be good at interpreting.
I’ve also elected, but still awaiting to see my schedule, to have most of my clerkship rotations at Boston Medical Center network. We have to do one “away” rotation, some people have elected to do rotations in sunny California, I’m going to do my “away” rotations in this state. I’m from California, there’d be some irony in me doing my away rotations towards home, would there? With any luck, as I don’t have a car nor want another, I hope I’m sent to a rotation that’s far enough away that I can use the provided school residence for living here in Massachusetts. There are rotations in the limbo zone, rotations far enough away to be difficult to get to, yet not far enough away that housing is provided — if that’s the case I might have to purchase a car, indeed a mutual loss for Gaia.
And lastly, I’m considering returning to California for vacation this summer. I’ve had time off, but I technically haven’t had a “vacation” since I started medical school. That includes not returning to California. I’m both excited and oddly nervous, it’s only been a couple of years, but I’m sort of afraid to see what has changed — less in location and more in relationships. Will I come off as a jerk? Have I changed? They told us we would, and I know I have. For the last two years, I’ve talked to nothing but medical students and doctors, am I even interesting to talk to anymore? I’m really excited to escape the medical student persona, it’ll be one of the last chances that I can, and I really hope none of my friends ask me questions about bowel movements. Fingers crossed.
I woke up throughout the night, each time I attempted to estimate the time till sunrise using the ambient light that slowly invaded my room. I wasn’t particularly anxious about the upcoming day, instead I think it was the fear of the impending jolt from the alarm that bothered me. Or, maybe it is more so that I live with other people and I hate the idea of waking them up with me. Either way, I woke up well before my alarm to shut it off. Checked the weather, a balmy Boston 20 F (-6.7 C), awesome — it was time to start the day.
Today, was the start of our Renal module. However, I don’t go to class, with the exception of discussions, patient sessions, and skills sessions etc. Instead, I watch later, at my own schedule. There are lot of ways to do medical school, and to each their own. For myself, I was going to the Cardiology unit of our hospital to go on rounds. Right now, I’m doing my first conceptual pass (hopefully 1 of 2) through cardiology for STEP 1. So, I took advantage of opportunity to concurrently round on cardiology inpatients.
I’m not sure if it’s realistic to do this for each block that I review, but so far it seems like an interesting spin on things. But, I figured I’m already paying an exuberant amount in tuition, might as well get as much as I can out of the experience.
So, earlier that morning, the cardiology team was to see 16 patients; a lot of them were overnight admissions. The team consisted of two cardiology attendings, one interventional cardiology fellow, two cardiology residents, and three medical students (including myself). This amounts, to what I can only imagine from the position of the patient, as staring at people like they’re in a fishbowl. I learned a lot of things since the first time I did this in the summer: read-up before coming, bring scrape paper, penlights are worth gold, try or nothing will happen, and pee whenever allowed to (bathroom strongly suggested). However, I’m still learning a lot of things when allowed on these excursions. Through lecture, I’ve been “exposed” to the material for most organs and a myriad of drugs. However, in internal medicine those random one off facts I marked on multiple choices became patients where I needed to know about amyloidosis** subtypes AL, AA, and TTR came up, gout vs pseudo gout (and the beloved crystal birefringence question) and their drug side effects, side effects of calcium channel blockers and their indications including selectivity, was Takayasu vasculitis causing the patients chest pain, vasculitis[?] and the dermatology consult, pheocytochroma (the adernergics strike back!), which medications cause Lupus like symptoms, hypertension management (should have brushed up on JNC-8), epidemiology of chronic kidney failure (remember, it’s the first day in renal medicine), and did I say vasculitis? It was a long day, but I got a warm pat on the back, and I was asked when am I coming back? To which I replied, “Day after tomorrow”. I returned home, watched the day’s lecture that I missed, did some practice questions for boards, and read up on the things that I felt I should have known, and looked up a few things I saw that day.
That night before returning to the hospital, I wrote down a list of goals for myself so I wasn’t just hanging out and stayed aggressive about my education. The cardiology exam, at least how it’s taught here, is pretty hands on and intimate (interestingly, a lot of patients say they enjoy the attention):
- Check for splinter hemorrhages on every “likely” patients’ fingernail beds — heard it was a thing, would like to see it myself.
- Palpate as many pulses as I can get my hands on, especially the patients with Atrial Fibrillation or peripheral vascular disease — I was really bad at the “difficult to find” lower pulses, I need to get better at this for the future. So, I thought if I feel a ridiculous amount of pulses I’ll be someone useful in a room later.
- When given an ECG, interpret it — I’m pretty decent, i.e. I can do the stuff they taught us in class; but, seeing a cardiologist interpret these things is magical. As an undergrad, I still remember trying to read an ECG in Physiology, I remember being blown away by even the concept of the leads. Accordingly, my favorite portion of physics was the electromagnetism section. Under the direction of a phenomenal mentor, I went onto do electrophysiology projects; there I interpreted ion channels, and gained a little confidence in looking at squiggly lines. This past summer, I had to drudge through a hundred or so ECGs to screen patients for a study. Now, thinking back it’s sort of funny, it’s not all that dissimilar than what I learned in freshman physics when I was working with circuits.
- Appreciate as many murmurs and abnormal JVPs as possible, including appreciation of Kussmaul’s sign — I remember going through murmurs the first time, I was absolutely horrible at them. I recall going to a workshop for murmurs, a physician cardiology fellow said, “It’s really hard to appreciate the differences of the murmurs, until you hear your first one and identify it on a patient”. She was right. Though, I’m not a murmur master, I can finally tell the difference between murmurs and the maneuvers necessary to amplify them. About JVPs, when I was a premed my grandmother past away, just before she passed away I saw her grossly elevated JVP myself. Dr. Google told me what it meant, so I’m comfortable with appreciating their significance; I just want to make a habit of appreciating them (just in case).
- Get more aggressive about checking for pitting edema, including attempting to better grade and describe its character.
- Follow-up on critical patients to see if the presented planned for therapy had the luck of a good outcome — I could do this by doubling back after rounds, or simply hoping onto my laptop from home to check-up on patients the team is assigned to; i.e. patients I’m allowed to follow. One of my favorite patients we visited passed away, Friday night, just as the attending bitterly predicted. Some patients got better, the amyloid patient was being prepared for discharge, a few were scheduled for catherization, and one had died.
- Pay attention to the management of the kidneys — I’m currently in Renal Medicine courses, so I should try to keep in mind that I still need to pass that exam later. Not surprisingly, there was a lot of between Renal and Cardiology Medicine: a lot of people with heart failure also have kidney problems. So, I’m paying more attention to goals of removing or adding liquid volume to patients. There’s been a good amount of overlap between class “take home points” and the stuff I see on the floor about titrating diuretics is applied to the patient I will lay hands on.
- Be more cordial with patients, especially when I’ve heard they haven’t had visitors for a while — one of the first things you notice going in cardiology assigned patients is their cognitive decline, and sadly I’ve noticed it’s also the time where some stressed families distance themselves from the patient. A large part of the cardiology exam includes assessing patients’ cognitive level, while not discounting biases (including our own), their education level, and their health literacy.
I returned to the hospital, this time I given a locker in cardiology to keep my stuff safe I was told. The day before, I wrote down everyone’s names so I wouldn’t forget who’s who. I’m really bad with names, though great with faces — I’m trying to get better at the former — that morning I forgot to throw this on my checklist, to be better at names, but I made the update. I set off to complete my check-list, I did.
Now, I don’t ask “What the hell is that drug, and what does it do?”, I wonder to myself what’s the indication for using it and removing it off of patients medications list. I’ve seen a variety of patients, with a variety of attitudes about their situation: some of them beautiful some of them spiteful. Over these days, I heard my first tricupsid regurgitation; or rather, I appreciated my first definitive regurgitation — in fact, I was bombarded by murmurs, so that it was no longer an exotic finding. Listening to the jumble of words and lab values for patients became less daunting of a task. I now feel less bogged down by the language of medicine and instead I’m looking forward to the transition from classroom to hospital floor. Perhaps it’s my gift for holding my bladder, given that I don’t have to do any of the heavy lifting yet, I like rounds and the complications and the piles of medications to think about. Given I was hoping to just be a doctor in the future, it’s surprising to see that previous work in data entry and another later entailed backend electronic database management come to use with the electronic health record navigation. I’m a little sad to see the skill come into play, but, I’m ready for electronic record drudgery so often bemoaned (and rightfully so, given the context). Because the senior medical students above me were great, they were essential to my experience and learning. And as usual, from them, I’m left hoping to meet the standards they set-forth. The learning went all the way around, the residents learned how to teach better from the attendings, the attendings learned an extra tidbit from “research questions” done by others. And me, well, I learned from everyone: I have a lot more work to do, but I’m going in the right direction.
**reference: amyloidosis is actually pretty rare, but we’re a center for amyloidosis so the incidence here is high, i.e. less esoteric of a fact and not just warped medical-pimping.