Pediatrics: Part 2

This week I completed the subspecialty portion of my Pediatrics rotation. Though I still maintain that Pediatrics is just not for me, it gave me some insight into the world of subspecialties (something we don't get a lot of exposure to this year....naturally, we have to learn the basics first after all).

It was definitely a whirlwind tour. In 5 days I rotated through Endocrinology, Gastroenterology, Pulmonology, Cardiology, Adolescent medicine, and a clinical research clinic looking at childhood obesity. I spent half days in some of the clinics, but fortunately we had the opportunity to spend more time in a few areas of interest (I chose to focus on Endocrine and GI).

And I realized a couple of things:

1. Specialists see a lot of unusual cases. Pediatricians in particular have the cornerstone on congenital disorders (problems that are present at birth). This week I saw kids with syndromes I had never heard of, and one case that most would not have heard of because it is so rare. What I had not realized about pediatrics was that some of these kids may stay with their pediatrician for life since they are more experienced in this area(I am a total sucker for continuity of care!).

2. Specialists see a lot of redundancy too. This wasn't exactly a surprise, but I was somewhat amazed that in 2 days of Gastroenterology I saw little variation on the themes of abdominal pain and failure to thrive. And in my morning of Pulmonology we only saw Asthma cases.

My insights are not groundbreaking by any means, but personally this was a helpful experience since these concepts apply to adult subspecialities as well. First, I did enjoy seeing some of the more unusual cases. I could tell that my attendings' years of experience made them well equipped to handle both usual and unusual presentations. I like the idea of becoming an "expert" in a field and not having to defer to someone else to make clinical decisions as primary care docs often have to. Naturally that leads to some redundancy. These doctors are able to tease out difficult diagnoses because they see the same things over and over again. I found that I liked the variety of cases I saw in Family Medicine (though there is certainly plenty of redundancy there too), so specializing might come at a cost for me. And perhaps many specialists temper the redundancy in their differential diagnoses by partaking in other things like research and clinical trials?

Next week I am headed back to the hospital to work in the Newborn nursery! Stay tuned...

Pediatrics: Part 1

I just completed my 2-week community pediatrics rotation. Well, really it was a short 2 weeks because Thanksgiving break was right in the middle. I was placed in a small practice (2 doctors and one nurse practitioner) in a Richmond suburb, about 20 minutes outside the city.

The first week was kind of a wash since we had orientation on Monday and my preceptor works a half day on Tuesdays and I was a bad(!) medical student and asked for some time off on Wednesday to pick up my bestie from the airport....so I only worked one full day in total. Heh.

And Thanksgiving was marvelous! I hope yours was too! Not to mention, I turned another year older last week.

This week I had to get serious and make up for lost time. I am pretty sure my preceptor thought I was an idiot (and I probably was one), but in my defense I have pretty much never seen pediatric patients before (see my previous post on family medicine in which I almost never saw kiddos, or see way way early posts on my first 2 years' family medicine preceptorships in which I also basically never saw kids).

So I had to learn quickly how to examine babies, toddlers and adolescents. And trust me, they all require a different type of exam. It was also hysterical to me when I would listen to a 2 week old infant's heart and lungs with my adult sized stethoscope and it would basically cover their entire chest (hyperbole intended). In addition, kids have different types of medical problems than adults: ear infections, asthma/allergies/eczema, and tons of upper respiratory infections. Sure, adults have some of those problems too, but usually it's one of the above plus hypertension plus diabetes plus osteoarthritis, etc. Dare I say I got bored. I also might add, I got sick! All those kids are just running around incubating viral disease! Ew!

I will try not to run this conclusion into the ground over the next 2 months of my peds rotation (though it might happen), but I think pediatrics is just not for me. I sort of knew this going into the rotation, and I tried not to let my lack of experience and interest cloud my judgement (though it still may have). In the last 2 weeks, it seemed that the parent was the patient more than their kid (reassurance, reassurance, reassurance). The medical problems were not very complex nor the diagnoses/treatments. There were almost no procedures (though this is likely the choice of the practitioners and not a generalized truth). There is always someone screaming/crying -somewhere- in the office and it caused me a constant, mild amount of stress. It makes me really uncomfortable to cause distress in a small child (even if I know I am not hurting them and they are just scared). Ok, one positive: some of them are pretty gosh darn cute.

Next week I will rotate through a bunch of different pediatric specialty clinics (endocrinology, gastroenterology, cardiology, pulmonology, and adolescent clinic) and the following week I will be in the newborn nursery at the hospital! Until then...

Family Medicine: Part 2

My one month stint in rural family medicine has sadly come and gone. In fact, I've already moved on to the world of Pediatrics. More on that later...I have been having trouble putting my experience in words (hence why I'm here 2 weeks late!).

So, way back last spring the department of family medicine asked us to write a wish list of sorts of things we would like to get out of our family medicine rotation. Many folks probably left the section blank or had a particular location in mind (ie, they could go home for the month). But if you know anything about the breadth of family medicine, from rural family docs to hospitalists to Emergency Room doctors to docs who deliver babies to your run of the mill suburban family practitioner to your urban underserved practice....the list goes on and on! Family doctors can do a variety of procedures too, like simple surgeries on the skin (for a large or deep biopsy, for example), joint injections, cryotherapy, delivering babies...there are probably many more, but you get the picture. Family docs do it all!

I knew that I was interested in family medicine back then, so I figured in order to experience a broad scope of family medicine I would have to land a rural rotation. When not too many doctors and large hospitals are around, doctors (hopefully) tend to do more for their patients to avoid having to send them out for many referrals and fancy diagnostic tests. Not to say that they are bad doctors, they just have to be more creative and use their diagnostic skills to save their patients time and money (shouldn't all doctors practice that way, really?).

I marked up my "wish list" with various procedures and rural practices and a few months later I was matched with the Crewe Medical Center! Crewe is only an hour and a half from Richmond, but it is definitely rural. The population for the entire county is only 15,000 and the nearest hospital was 30 minutes away in Farmville. Perfect, I thought!

As I said in my last post, there is a division of labor at CMC. The 2 nurse practitioners see all the well child visits, medication refills, and gynecological visits (basically, all the routine visits). That frees up the 3 doctors to see acute cases and uncontrolled chronic disease. Since I only worked with the doctors, that narrowed the scope for me quite a bit (I mostly only saw adults with acute and chronic disease), but it worked out for the best I think. I learned a lot of medicine in those 4 weeks! Dr. Hall (who I worked with most days) liked to joke that I was X patient's endocrinologist or Y patient's cardiologist. Perhaps a bit of a stretch, but fun nonetheless.

I could go on and on singing the praises of my month in Crewe, but I think I'll stop here. In short, I learned a ton, I loved the practitioners and patients, and I even narrowed down my list of specialties to one. See, I loved family medicine, but it wasn't really family medicine in my eyes. I saw acute and chronic adult medicine (internal medicine...right?). It will take more soul searching to be sure, but I don't see why the extra training in pediatrics would be of benefit to me if I really just want to see adults. Family medicine opens many doors since you can practice in so many settings, but I think Internal Medicine has many, if not more doors. It just narrows the patient population a bit.

Family Medicine: Part 1

I'm back from the boonies for the weekend and I wanted to report on life in Crewe! I usually wait until the end of a rotation, but I'm just too excited to wait!

First, I'm staying at a lovely Bed & Breakfast called the Grey Swan Inn in Blackstone, VA just down the road from Crewe. It's cozy with a fireplace and endless bookshelves and floral sheets like my Grandma's. Every morning I eat breakfast with the other guests (they have been from near and far--Washington state even!). I have sat with an astronomer, two gents who are working on remote controlled helicopters for the military, and travelling substance abuse counselors to name a few. The Innkeepers make fresh breakfasts every morning with bottomless coffee, thick slices of bacon, creamy eggs, rhubarb crisps, homemade pumpkin butter...you get the idea. Heaven.

After filling up, I hop in the Mini and drive about 20 minutes through the countryside and down tree-lined highways bursting with fall colors to Crewe Medical Center. Patients are always lined up well before I arrive, since the clinic allows walk-ins. Dr. Hall and I review lab results that came in from previous days before seeing our first patients. We typically see patients non-stop until 2pm when Dr. Hall decides it's time for a lunch break (see, that big breakfast is key!). Then we power through until 5-6pm.

Since CMC is a little isolated (the nearest hospital is almost 20 miles away), we double as an emergency room too, it seems. The doctors joke as we sometimes "admit" patients to CMC to give IV fluids if someone is orthostatic or to suture lacerations. We also see the full spectrum of patients (young to old, well to quite ill), though many also make the trip to Richmond to see specialists. There is some division of labor within the practice though, as there are 3 docs and 2 Nurse Practitioners. One of the docs sees most of the kids, while the NP's see most of the OB/Gyn.

I mostly see chronic and acute adult medicine. I have helped diagnose and treat diabetes, heart failure, osteoarthritis, nephrolithiasis (a fancy word for kidney stones), a diverticular abscess, and a host of other problems! I have also gotten to do steroid injections of the knee and sacroiliac joints and my first fecal occult blood test.

In next week's edition I will talk more about my progress as a baby doc. This is my first real medicine rotation (on surgery and neurology most patients came in the door with a diagnosis), so I am finally getting to work on my differential diagnosis and reaching way back into the dusty cobwebs of my brain-space to remember how to test and treat for these diagnoses. It was a steep learning curve this first week, but I know I am making good progress!

Family Medicine

Tomorrow I am moving to Crewe, VA to start my family medicine rotation. I requested a rural location for this month, and apparently my school obliged!!

Neurology

Another rotation down!

Let me first explain the breakdown of the neurology rotation. We spend a month on the service but it is divided into thirds: wards, consults and clinics. The reason for this being that each service sees very different kinds of neurological cases. On wards, one is likely to see a lot of patients with strokes or epilepsy. Consults is more of the same with some oddballs added to the mix. A patient on, say, the cardiology service might suddenly develop leg weakness and the Neuro consult service would be called on to evaluate the patient's new problem, though their primary reason for being in the hospital is not a neurological issue. On the clinic service, anything is fair game. Headaches, Parkinson's, Alzheimer's, Epilepsy, Stroke follow-ups, Multiple Sclerosis and a variety of movement disorders.

Disclaimer: This blog has become my primary place to record my impressions on a given field to help guide my future career decisions. These are only my personal opinions based on a very limited exposure and are therefore not meant to dissuade anyone from entering a given field, or to detract from any department at this institution.

The pros and cons of Neurology as I see it:

Pros:

• The neurology residents were top notch. Nerdy-cool, well-adjusted, friendly and they seem to love to teach!
• Procedures: I helped perform 2 lumbar punctures (you may know them as spinal taps) and learned to place nerve blocks for people suffering from certain types of headaches
• The physical exam in neurology is extremely detailed and it's pretty fun to try and localize the lesion (be it a stroke, tumor, abscess or a peripheral nerve problem) within the nervous system based on your exam findings.

Cons:

• Lengthy and expensive work-ups (especially for strokes) with seemingly little knowledge gained or benefit to the patient
• Very few diseases in Neurology have cures; treatments are symptomatic or merely intended to slow disease progression
• Neurological diseases are devastating. It's heartbreaking to see patients with disabling movement or speech disorders, especially when they are entirely cognizant of their deficits.

One thing I am starting to learn about myself is that I love instant gratification! I like to see a patient, diagnose the problem, provide some sort of intervention, and see some immediate improvement in the patient's condition. I guess I am just simple minded like that. It's just funny because I used to think I would enjoy spending a lot of time educating patients and trying to help them modify risk factors for disease. Perhaps my ideal career will combine an intervention with some long-term/preventative care.

S/P Trauma

One aspect of the surgery rotation I have neglected to mention elsewhere is Trauma. On weekends during the 2 month surgery rotation, we med students take 12 hour shifts in the trauma bay. For me, it was a dreadful part of the week.

My first Trauma shift took place on Sunday night after my first week of surgery. That means I went into the hospital at 7pm on Sunday, worked through the night, and then joined my primary surgery team at 5am and worked an entire work day--almost 24 hours total. Those who know me well know that I am far from a night owl. I like to be tucked in bed no later than 10 or 11pm. On surgery I regularly went to bed at 9pm or earlier given the early wake-up calls, sometimes as early as 4:30am.

That first night on trauma was perhaps one of the busiest of my 2 months. Students typically take turns "gowning" for traumas, meaning only one person actually needs to dawn the blue surgical gown, hair cap, mask and gloves. That person's primary objectives are to cut the clothes off the incoming trauma patient, get them warm blankets, and help the team roll the patient during the physical exam.

If you've seen medical shows on TV, you more or less know what the scene looks like. About 10 people are crammed around the patient trying to establish an airway, IV access, draw blood for labs, and assess the extent of the patient's injuries. It's an intimidating situation to say the least, especially for someone new to medical training. It wasn't uncommon to simply get pushed aside because you were taking too long. Nothing personal, it's just that it could be a life or death situation and things need to happen quickly.

After the airway is established and the initial assessments are done, the room clears out. Often the patients were then left alone, waiting for X-ray or the CT scanner to open up , or for a bed in the hospital to become available. Some needed lacerations sutured or bones reset. Needless to say, the trauma bay isn't a very warm and friendly place. Get in, establish diagnosis, get out.

My first patient was a "delta" meaning a more critically injured patient (as opposed to an "echo"). He was a young man out riding his motorcycle on a rainy evening and flipped over his handlebars, leaving him a quadriplegic. It was clear early on that this man had a severe spinal cord injury; he couldn't feel a bad break in his femur and even gentle touch on his arms caused him shooting pains.

The reason I struggled to like trauma began with that first trauma case. Although I cared that this young man was seriously injured and wanted to see an end to his suffering, it's hard to connect with patients in such a high speed environment. Since I never got to "know" patients like I have time to do in most other situations, I struggled to see them as more than a case or a procedure. Of course the point of trauma is to quickly direct patients to where they need to go, either to surgery or to be admitted for observation, not to bond and share warm fuzzies.

This is in stark contrast to how I see myself practicing medicine though. If I find myself in the trauma bay again, I think I will at least have more confidence and a larger skill set to help me function more effectively, but I think the pace and atmosphere are just not for me.

S/P Neurosurgery

Yesterday was my last day on Neurosurgery, but more importantly it was the last day of my Surgery rotation!

Neurosurgery is not likely a field I'll be considering when it comes time to decide, but I signed up based on my previous work/interest in neuroscience and for the chance to see living, breathing neuroanatomy.

The work neurosurgeons do is indeed incredible, handling pathology of the brain, spinal cord and surrounding structures. I saw procedures to relieve chronic back or neck pain, to remove brain tumors, to decrease tremors and rigidity in Parkinson's patients, and even a vascular surgery to remove plaque from the carotid artery.

I'm just not sure my personality is a good fit for neurosurgery. It takes a certain kind of person to be confident about operating on such delicate anatomy.

Next up, Neurology.

S/P: Urology

Another rotation down.

I spent the last 2 weeks learning about Urology, a field I have professed interest in since day 1 of medical school when I casually announced to my anatomy dissection group on our first meeting that I would love to handle the dissection of our cadaver's nether region. When the day came, I wielded my scalpel with a degree of avidity that no one who was nearby has forgotten (no really, they remind me whenever the topic re-surfaces). I then spent a few mornings of the following summer shadowing a urologist in a community hospital back home. Though I only saw the clinical side of her practice (urology is in fact a surgical field), my interest was still piqued and I sought out the Urology rotation as my Number 1 (and No. 2, actually, to reinforce the seriousness of my choice!) preference for the surgery rotation.

Skip ahead to approximately 2 weeks ago. Reviews from my classmates who had done the Urology rotation prior to me gave mediocre reviews of their experience and I had just come off of a rather excellent month of Surg Onc (though admittedly, my mood had sunk considerably by the end of the month too). Maybe we are all just tired. Let's face it, surgery is pretty physically demanding from the long hours to the standing around an operating table to the not peeing or drinking fluids or eating on a regular schedule (or sometimes at all) to the not exercising...It's easy to see how one's spirits might be crushed by this sort of lifestyle. Anyhow, I found myself less enthusiastic than I anticipated going into the Urology rotation.

At the start of my rotation I quickly learned that I had chosen a bad time to be on urology. Several attendings would be on vacation and the service was slow as molasses. Good for hours. Bad for urologic experience. The majority of my first week was spent in clinic seeing kids with voiding dysfunction (a general condition of irregular bowel and bladder emptying) or vesicoureteral reflux (the back flow of urine from the bladder into the ureters or kidneys, predisposing the kiddos to urinary tract infections) and adults with kidney stones, benign prostatic hypertrophy (BPH) and prostate cancer. Not to complain too much, but I did come here to see surgery! On the bright side, I did get to improve my clinical skills somewhat.

Week 2 had a bit more surgery on the schedule so I spent much less time in clinic. However, the majority of the cases I saw were "under water" (aka cystoscopy, where the surgery is performed through a rigid scope inserted into the urethra) or robotic (where the surgeon operates at a console that controls laparoscopic instruments inside the patient). Not much for a lowly medical student to do but sit in the corner on a stool and watch the monitors. Since I was not standing at the operating table, I was generally forgotten and not much teaching happened during these cases as is typically done during an open surgery. Dare I say, this was a tad boring.

I am hesitant to discount Urology as a potential career, even though I didn't have an ideal experience. The residents and attendings were extremely like-able, the patient population is varied (male/female, young/old), and there is a good balance of clinic and procedures. I guess we'll just have to see how the rest of this year goes!

POD1 S/P: SurgOnc

That's surgery speak for post-operative day 1, status/post surgical oncology. AKA, my first rotation is over! And it's a bittersweet day indeed.

1. I loved surgery more than I thought possible. It is a mind-blowing task what surgeons do every day. To first earn the trust of their patients, then be allowed to put them to sleep and cut them open and put their hands all up in their insides...with the ultimate goal of fixing something and putting them back together again. And I do love putting my hands in people's insides! As my attending noted yesterday, it does not require such a high degree of trust to put a patient on, say, an antihypertensive medication (which the patient can opt to take or not), to follow up with them and tweak the dose as needed. It's just a different kind of relationship.

2. The surgeons and residents themselves were fantastic people who I would be honored to work with. Despite some of their less awesome quirks and occasional outbursts in the OR, they are a fun and intelligent bunch.

3. The patients, the majority being people who have cancer (though not all!), are phenomenal. A few patients were with our service the majority of our month on duty and we were able to form an admittedly strange but significant bond with them. Strange because of the types of conversations we have, either on rounds ("have you passed gas today?), or while packing a wound ("say, what's going on in the world?"). Others were in and out of the hospital quite quickly, but we saw many in clinic for follow-up or, unfortunately, back in the hospital due to complications. Some were rather sad, palliative cases. Some were there for curative treatment and watching their progress from a sick, surgical patient to a healthy patient walking out the door is really satisfying.

So, that is that.

This next month is my surgical subspecialty month where I will spend 2 weeks on Urology and 2 weeks on Neurosurgery.

Summer has officially come and gone. Today was the last day of our orientation week where we tried our hand at intramuscular injections, Foley catheter insertions, phlebotomy, and learned how to use our hospital's Electronic Medical Records system. Though I can't say that I feel like an expert at any of these tasks, at least we got to try these procedures on plastic models or our classmates before we start performing them on patients.

On Monday, I'll be at the hospital bright and early for my first day of Surgical Oncology...I'll learn a little about the pre-, intra-, and post-operative care of cancer patients. During the month I'll also get to take call in the Trauma department. I will miss sleep and regular home-cooked meals and going to the bathroom at my leisure, but I am definitely excited to climb this first mountain of 3rd year! Excited and scared.

So...I PASSED STEP 1 OF THE USMLE!

Though folks outside of medical school may not be able to comprehend the fear induced by this exam (it stems somewhat from the thought-seed that is planted at the beginning of medical school that Step 1 dictates much of your immediate future, ie residency, and also from the demoralizing month of studying and practice testing that takes place prior to the exam). Anyway, I believed deep down (and no wise words from outsiders could shake it) that I had really, truly failed. True, it's an extremely rare event, at least at my medical school. And true, I passed all the practice tests. But the length and arduousness of the thing left me doubting myself.

Let this be a lesson to myself: doubt not. There are many more of these hurdles ahead and let's not waste our time suffering such bouts of stress in the future. Life goes on (obla-di-obla-da)!

Ok, now 2nd year is really over. Final exams taken. Grades finalized. Promotion letter received. This minor little thing called the Boards taken. And most importantly, vacation started.

I am writing from a lovely little screen porch overlooking Benton Pond near Otis, Massachusetts. Not a thing to do but drink coffee, lay by the water, read for-fun books, and take photos of fungi. HEAVEN.

Next up is a trip to my grandma's house in Coeur d'Alene, Idaho for our annual 4th of July celebrations and fun at home in Portland!

There have been a few minor changes to my surgery schedule in the fall, but let's worry about that at another time. The dock is calling...

Another Crunch Month update from the desk (or kitchen table, if you will) of almost-Dr. V! I just wanted to share with you guys what Friday nights look like during Crunch Month. Which, by the way, is NEARLY over. 10 more days of hardcore study action before T-day. Thank goodness, I have pretty much had it with rigorous daily study schedules. It's summer!!

And now a little about how suppositories work:

The superior rectal veins drain to the portal circulation via the inferior mesenteric vein. The middle and inferior rectal veins, however, drain to the systemic circulation via the internal iliac and internal pudendal veins, respectively. Thus, two-thirds of the venous drainage of the rectal region goes directly into the systemic circulation, thereby increasing the bioavailability of drugs that are otherwise highly cleared by the liver after oral administration.

You are welcome.

Just a quick update from the desk of almost-Dr. V. We're almost at the half-way mark! Boards study is going better than expected. I think being on a strict(ish) schedule suits me. I study as hard as I can manage during designated study time and am able to feel less guilt when taking the breaks. My only fear is that nothing I learn will stick, but there is plenty of repetition built in to the study plan, so I won't worry too much!

Also, I moved my test up by a day to allow for summer travel plans (haha!). Just 22 days left on the wee counter!! It seems so soon, but not...

On an unrelated note, you must see Bridesmaides! I laughed until my face hurt and then some!

It's here folks. Tomorrow is the first day of my boards study month, or "crunch month" as we like to call it. Classes ended uneventfully on Friday and I spent this last free weekend celebrating with friends, cleaning house, trimming trees, pulling weeds, and running tons of errands (all the things that have been neglected over the last, uh, year...) to prepare for this next phase.

As you can see, I've got all the supplies I'll need. Highlighters, books, flashcards, and a pound of delicious Lamplighter beans. Here we go!!

Just 47 days remain on the USMLE countdown! That means posts are about to become sparse here on S.R. I may still check in once or twice, but let's face it: I'll be locked up with a pile of books most days (and nights) with minimal human contact and probably won't be emanating much thoughtful prose. That said, I have tweaked my schedule to allow for more wiggle room near the end of the month and will try and stay as positive as one can.

In other news, my group-mates and I met yesterday to decide where we will each spend our surgery rotations (certain services require at least one or two students to be on staff, so not everyone can do what they want). For now, it looks like I'll be spending most of the two months at the Veteran's hospital doing a month of general surgery followed by a month of urology and neurosurgery. I can't wait! I've heard that the VA is a great place to learn and tends to be a more relaxed atmosphere than the academic center. Before you know it, I'll be trading in this pile of books for...a new pile of books...and holding retractors...and, who knows? Doctor-y stuff!

This is it, you guys! We are in our last purely didactic class of medical school: the musculoskeletal system. I admit, it's not a class I was looking forward to, but so far I have found it enjoyable. Which is good because it's not like I'm distracted or anything. Definitely not about this insignificant exam we have coming up in June, nor about picking my first rotation schedule. Nope! Not at all!

Also, bunnyfish resting atop the completed pile 'o syllabi:

Today was makeover day here at Synaptic Reorganization! I have added a Tumblr page so that I can add miscellaneous content and photos without disrupting the flow of med school-related news. On the side of the page is a handy Tumblr feed (thanks to Jeremiah!), or you can subscribe to the Tumblr feed by a separate means. Or you can go on ignoring me....

The blog itself got a wee face lift as well. Just a little spring cleaning!

After nearly 3 years of neuroscience research and a few publications to show for myself, you'd think I'd be down with this neurology course. You'd be thinking WRONG! I feel like I am fumbling through this material with beer goggles on (hello, chorea!).

On the bright side, I have planned my summer vacation and just purchased a swimsuit and 2 new books for the break. It may be 2 months away, but it's all I've got to look forward to, people.

Summer goes like this:

Otis, MA: 6/25-7/1
PDX, OR: 7/1-7/23

With a reading list of Bossypants and This Won't Hurt a Bit (and other white lies): My Education in Medicine and Motherhood by one of my favorite bloggers!

Rotation schedules are in!

Next year goes like this:

Surgery
Neurology
Family Medicine
Pediatrics
Internal Medicine
Ob/Gyn
Psychiatry

Tick, tick, tick...

Time sure does fly. Women's health ends on Friday and then we only have Neuro and Musculoskeletal before "Crunch Month" begins. The month in which I crawl into my study cave and emerge a month later as a butterfly...or hopefully something resembling a human being, at which point I will take my Board exam and get on with my life.

Today I met with Dr. Costanzo to go over my study plan. Although it was silly of me to have any doubts, most of my fears were calmed and she definitely left me with a sense of I-can-do-this-ness.

Here is roughly what life will look like for 33 days:

8 hours of studying, 3 hours to exercise, eat and relax, 3 hours of practice questions, bedtime. Lather, rinse and repeat.

In other news, this was a big week in my medical training! Yesterday I completed workshops on rectal, pelvic and male genital exams. Though I am far from proficient, hopefully when it comes time to do these exams next year I will at least give patients the impression that I know what I'm doing!

It has been surprisingly rare that I question my decision to attend medical school. The rigors of the preclinical years (these first two years) are certainly manageable. Stressful at times, but I think my classmates and I cope pretty well.

Enter Behavioral Sciences II. An intro to psychology and a smattering of topics that are important but don't fit in elsewhere in the year. Some of the cheerful topics included the high rates of physician suicide, drug and/or alcohol abuse. It was no secret to me upon starting this process that medicine is generally a high-stress field. However, these alarming statistics combined with horror stories from residents and upper level medical students about life, or lack thereof, down the not so distant road for the first time left me wondering what the hell I got myself into. Clearly not everyone copes in the above mentioned ways, but a life in any way resembling those things is not what I have planned for myself, nor my dear friends and colleagues.

Luckily, there was a light at the end of the tunnel: spring break! I got to spend an entire week visiting with family and friends, catching up on some Board review, and some much needed me-time.

Transitioning back to life in Richmond and school wasn't easy, but I am now feeling back in the swing of things and enjoying the Women's Health course. And now that we are back, it's full speed ahead. No rest until the Boards are over (more or less). Woo hoo!

Second piece of news: The M3 year lottery has officially opened. This means my classmates and I are busy pouring over the 12 available rotation groups to decide which one best fits our schedules or fields of interest.

Our required rotations next year include psychology, obstetrics & gynecology, internal medicine, family medicine, neurology, pediatrics and surgery.

In just a few weeks (ok, more like 6) our groups will be revealed and our futures will be somewhat more certain. For now, M3 year remains part of the nebulous black hole that exists between summer break and graduation.

I have so much to report! Unusual, coming from someone who does little besides sitting at a desk reading syllabi and downing extra large coffees.

This past weekend I participated in a dental school-sponsored event called Missions of Mercy Project (or MOM, for short). Several times a year, the dental hygiene students, dental students and faculty put on these massive events to provide free dental services to rural communities. Field clinics are set up, resembling a MASH unit with portable dental chairs, dental units, x-ray machines and sterilization facilities. Patients start lining up the night before to ensure that they have a place in line that guarantees that they will receive treatment.

It was unlike anything I've ever experienced, really. Some patients I spoke with did spend the night outside, others arrived from 2:30am and onwards to save a spot in line for treatment. We were set up in a high school, where the auditorium housed triage, hallways held lines of patients sorted by big yellow signs reading extractions, oral surgery, and hygiene. Finally, the gymnasium was ground zero, where all the magic was happening. Rows of portable dental chairs were lined up: hygiene on one end, fillings and extractions in the middle and surgery on the other end. I stood on the sideline for at least an hour just taking it all in. The smell of drilled teeth filled the air. Towards the end of the day, I shadowed a young dentist in the extractions area. Our patient said he had been in pain from a decayed wisdom tooth for six months and he was ready to get it removed. It took less than 10 minutes to drill and extract the tooth. A couple of stitches, and he was on his merry way. What an awesome gift!

The med students' role was less glamorous. We worked on the front line, ahead of triage, making sure the patients were fit for their dental procedures. In two days we screened about 700 patients' blood pressures, blood sugars, and medical histories. Things moved quickly, but I did note the excitement in some patients. In particular, one woman told me she had had had all her teeth removed earlier this year and was going to receive a full set of dentures that day. Others were more tense and afraid...justifiably so. One surgeon told us he had removed all of four patients' teeth that day. It was a bloody, gut-wrenching scene in the gym. But I am trying to focus on those who came away from the day smiling.

From the desk of Almost-Dr. V:

When prepping for exams, it is of utmost importance that one stay hydrated and color coordinated.

In case I didn't make myself clear in my last couple of posts, I LOVE GI. Intestinal mucosa, hepatobiliary tree, Ampulla of Vater. I. Love. It. All.

In other news, I am participating in a school-wide Ironman challenge on top of the other fitness activities I mentioned before. It's not the real deal; we get nine weeks to complete 26.2 miles of running, 112 miles of cycling, and 15,000 meters of rowing (or a lot of swimming if you prefer, and I do, but it takes longer and I have to keep up with med school afterall). Still, it's fun and we get a commemorative T-shirt for completing the challenge. I hope to finish a little early so I can focus on running for the 10k coming up in March!

And this is the new me. Well, kind of. I started this little strength training routine back in December, when I could barely lift the 45 lb bar and my chin-up count was 2. Now I am squatting 100 lbs, benching 75, and I did 11 chin-ups the other day! I feel stronger than ever.

And here is another gem from the syllabus:

"Always remember this mandamus, never forget to put your finger in the patient's anus."

Loving the GI course!

“HERE IS ANOTHER EXAMPLE OF ACUTE GASTRITIS, AND THIS ONE IS KIND OF FUN BECAUSE HERE WE SEE FUNGAL HYPHAE”

(Borrowed from the lovely Almost-Dr. K's blog.)

Plus, today, I got to listen to lectures on bowel disimpaction and diarrhea for hours on end in secret at the coffee shop. What the other patrons don't know can't hurt them.

Almost-Dr. V makes house calls!

Today I'll be joining the house call team on an outing to see some of their patients. The team proactively treats these older, sicker patients to prevent the need for hospitalization, rather than bringing them into the hospital where they are exposed to any number of nosocomial (hospital-related) infections.

I doubt we will see any young healthy kids, like the picture depicts, but it's sure to be a great learning experience!

A new year and a much larger pile of paper for our dear friend bunnyfish to sit on. In a month's time, it will be at my hip level (2.5 feet, give or take?)! Hard to believe.

I don't think I'll have time for the insightful new year's post I had imagined a few days ago (lo! I have a quiz to take tonight and a report to prepare for already). However, I do want to share a few thoughts, or resolutions if you will, before they vanish from the front of my brainspace with the onset of the Cardio block tomorrow.

#1 Watch the attitude. I don't think I have a particularly bad attitude about school or what lies ahead, but I have caught myself taking things and people for granted. I think it's something we should all be mindful of. Over the break I interacted with a few pre-meds and was quickly reminded of how lucky I am to be in this boat and how badly I wanted to be here for such a long time (and still do!). These pre-meds are just as qualified as I was when I applied, and they have been less fortunate in the admissions department. It is truly a blessing to be sitting where I am today.

Also, I often proclaim that I have learned nothing in this year and a half or whine that the information is simply not sticking with me. It's just not true--in fact, there have been several occasions where I knew exactly what was going on with a friend or family member's health--and I need to remember that in order to stay positive.

#2 Have more fun! It won't be easy...we are already stepping up the game this week in preparation for the Boards, but I have to remember to spend time wisely and make room for non-medical activities. I have already more or less given up hiking, crafting, reading for pleasure, and even photography (a pursuit that probably doesn't take that much time, but has nonetheless fallen by the wayside). Luckily, I always find time for my biggest joy, cooking. A girl's got to eat afterall!

#3 Diet and exercise. I am probably most serious about this category. My gal pal and I have started a strength training routine at the gym (ladies! get pumping iron!) and I've signed up for my first 10k this spring. Although it's high on my list of priorities, it's been one of the easier goals to keep this year. Having a friend at the gym and a race date are keeping me on track. My diet is ever-changing, and as I learn more about nutrition, my goals change too. I'm not sure exactly where I stand at the moment, but nutrition is almost always on my mind.

That about sums it up. I wish you all a happy new year!!